BPOL2014-111778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ITP -606-1-44 117
Property Address: 53600 AVENIDA DIAZ
APN: 774112004
Application Description: POOL
Property Zoning:
Application Valuation: $15,000.00
Applicant:
JERRYJUHL
53600 AVENIDA DIAZ
LA QUINTA, CA 92253
Taff
U 4. Q"VOICE (760) 777-7125
v FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/21/2014
Owner:
JERRY JUHL
53600 AVENIDA DIAZ
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.::CONV:140528101253003567
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($F00)-:
(V 1, as owner of the property, or my employees with wages as their sole
nsation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec. B.&P.C. for this reason
Date: 12111411 Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjurythat there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
c
Lender's Name:
Lender's Address:
Contractor:
JERRY JUHL
53600 AVENIDA DIAZ
LA QUINTA, CA 92253
(760)902-5784.
LIc. No.::CONV:140528101253003567'
►�
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier:- Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the bor Code, I shall forthwith
comply with thossee provisions.
Date: CZ/ Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant,. each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to e�ter upon the above-
mentioned property for inspection purposes. / /) ' .
Date: Z y Signature (Applicant or Agent): °
AGCOUNTi., QTYa.
(d fr<i''�i,-!i
AMOUNTS 3,.'PAIO PAID DATE'.
a k. ;. DESCRIPTION zry€
f� Y z.<
BSAS 561473 FEE
101-0000-20306 0
$1:00
$0.00
FINANCIAL
INFORMATION
"`3;Kr.h:xt:r4 P�fE a3
RECEIPT #
-
AGCOUNTi., QTYa.
(d fr<i''�i,-!i
AMOUNTS 3,.'PAIO PAID DATE'.
a k. ;. DESCRIPTION zry€
f� Y z.<
BSAS 561473 FEE
101-0000-20306 0
$1:00
$0.00
., 1
A.411,
BY
!4i ve'.F bx3 - x4r4ci''R'%r—`Fii $4.�,Yd., t. . e„ J
METHOD �"
"`3;Kr.h:xt:r4 P�fE a3
RECEIPT #
�.;-
44HECK # •' CLTf) BYs
:. kPAID r r '
A�:` tF
.�- r_s-z._ t '_?_.
. k'. y
�,'t.�,.'s...>
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00- $0.00
K.'4r »`i:. �_R''i �:F4tKY`.i.F
DESCRIPTION a
.r-rt:LY4. YF`ai ntt'a,.i,*�.
ACCOUNT
�. ..3"i'x' 3 x',;r
g, AMOUNT e
p.,";::a"'Et xi
PAID^ r
PAID DATE
r ".�`,,.�,����.,�,"3,'?tE'x.,
s <_
=QTY
?u'�:�s�t��k,e.s.•,:.:.,f:.Er.
.��'.�..i„a�;
SWIMMING POOL/SPA
.161-00,00-42404
0
$18129
$0.00
R � l'F d �za; ,x •' Y `4x
',�`�x,� # �.a:... ; k i . t x �`.
�i.S.i`.t
d - ,5 L-1. � sg. i`'c� "� 1 S ..'�Ef'�k �
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`��"CHECK�#,�
l
�'€.�CLTD BYE
.. s".a__, n. .,..-.J..: a'iZ."..s• > > •..:.,:Pi iSi'{4-Y.r41E Y4.:.
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<.i n5' <,'. a'1'" K4 , e.Pd�.Xu
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a•3<r.;.
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s 4
PAIU DATE:'
,, ��...�, � �<,;DE5CRIPTIONrx ��:.�����:
..�''����r����,..��,. 4.,. �:�''xb�
�°4,.E•,.,
..;i,. cAMOUNTk ��x
��� ��PAID�� �-�
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
$0.00
��
y'�.
RECEIPT #�
CHE
EC
CLTf);BY;,'r
ri+S�RAIQrBYa
•:�-', .,.:. .a. :.. s.. .:., fi.<!.., pm'.
;
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Total Paid for POOL /:SPA: $279.91. $0.00.
TO0.00
1
r
Description: POOL
Type: POOL Subtype: Status: APPROVED
Applied: 11/21/2014 KHE
Approved: 11/12/2014 KHE
Parcel No: 774112004 Site Address: 53600 AVENIDA DIAZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 191 Lot: 21
Issued:
UNIT 19
Lot Sq Ft: 0 Building Sq Ft: 0' Zoning:
Finaled:
Valuation: $15,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: POOL AT FRONT COURTYARD. [DENISE POELTLER ENGINEERING). ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER
INSEPCTION. EQUIPMENT ENCLOSURE NOT INCLUDED. 2013 CODES.
Applied to Approved
Printed: Friday, November 21, 2014 4:51:23 PM 1 of 2 r
SYSTEti1S
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT.
JERRY JUHL
53600 AVENIDA DIAZ
LA QUINTA
CA
92253
(
Printed: Friday, November 21, 2014 4:51:23 PM 1 of 2 r
SYSTEti1S
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL"
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$0.00
PC
Total Paid forP00L / SPA: $279.91 $0.00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL"
BOND INFORMATION
Printed: Friday, November 21, 2014 4:51:23 PM 2 of 2 1717
syszrnns
City of La Quinta
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P.O: Box 1 SO4
a 78-495 Calle Tampico
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Building Permit Application and Tracking Sheet
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fid' °F ,('WauixYa
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1564
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted your name listingyour elf as the builder of the 'property
improvements specified at m (9� A.1L , 01 2 U6,UvJ4r
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us M our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
4I understand building permits are not required to be signed by property owners unless they are responsible for the .
on ction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
s if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
0
isI understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
ts and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
un er state and federal law.
�'ent,,withhold
understand if I am considered an "employer" under state and federal.law, I must register with the state and federal
ve payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
co ensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
?slliI understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
ubc
es cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
tractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
contract with a licensed general building Contractor.
I
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liabie for arty
fin ial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
or anship or materials.
JI understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
/ 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
V rty legally and financially responsible for proposed construction, activity at. the following address:
11. I a ee that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
cabl aws and requirements that govern Owner -Builders as well as employers.
heo
2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
rovided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
ne who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner
Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work): 0 \1
Project Location or Address:
Name of Authorized Agent: 1 „�t Ctr (r,� p W� Tel No —
Address of Authorized Agent:?iEDl►�/
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is requir to be pr s ted when the permit is issued to verify the rope``rty owner's signature.
Property Owner's Si ature: V Date: j� L
l
/
'
CITY OF LA QU UKNTA SUB -CONTRACTOR LIST
� Only p1lensono appearing on this list ortheiremployees are auihohaed.to work
on this job' Any changes to this. list must be. approved by the Building Division prior to nornnnuncarnont of work. Failure to comply will result in a stoppage of work and/or the voidance
U
of building U cornp|etod'byapp|ionnt. ^C)n File" iunot an acceptable response-..
MP Ins
. .....
Classification
License Number
Exp. Date
Exp. Date
License Number
Exp. Date
-8)
(xxxxxx)
(xx/xx/xx)
(e.g. State Fund, CalComp
(Format Varies)
(xx/xx/xx)
(xxxx)'
(xx/xx/xx)
EA
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POO st)a
01
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,ply
CDNC
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
/APPROVED
FOR CONSTRUCTION
A V . .D -TA