BPOL2016-0108LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 867946 1 y�
Date: 6Conte ntrac�•tor:
IF
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't
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
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, 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:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Len
Lender's Address
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty B perjury one of the following declarations:
I have and will maincain a certificate of consent to self -insure for workers'
compensation, as provided for oy Section 3700 of the Labor Code, for the performance
of the work for which this perp- it is issued:
I have and will maintain workers' compensation. insurance, as required by
SI!
on
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 Labor Code, I shall forthwith
comply with those revisions.
'Date: !: _A.Pp` liicc t:
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UN L,
AND SHALL SUBJECT AN EMPLCYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND D01LARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES ASPROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is herby made to the Building Official fora permit subject to
the conditions and restrictions yet 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 applica:ion , the owner, and the applicant,. each agrees to, and
shall defend, indemnify and hol I 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 day: from date of issuance of such permit, or cessation of
work for 180 days will subject p-2rmit 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 enter upon the
above-mentioned property for i ispection purposes.
Uak e: Sign ature,(Applicant.orA nt):
_i
cu .
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D "`'���
D
LA QUINTA, CALIFORNIA 92253
FAX (760) 777=7011
COMMUNITY DEVELOPMENT. DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/26/2016
Application Number: BPOL2016-0108
Owner:
Property Address: 54899 WINGED FOOT'
JOSEPH GANSEN
APN: 775330015
Application Description: MON BURNS / POOL REMODEL
92253
Property Zoning:
a
Application Valuation: $12,000.00
Applicant:
JUL 2 Z0t6
Cortractor:
DESERT POOLS CONSTRUCTION
DESERT POOLS CONSTRUCTION
83370 VECINO WAY
CllY OF LAQUINTA .
83370 VECINO WAY
I"IDIO, CA 92201
COMMUNITY DEVELOPMENTDEPA
INGO, CA 92201
(760)578-6281
------------------------------
-------------------------------
Llc: No.: 867946
----- ---------
----- -------- - - - - - -
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 867946 1 y�
Date: 6Conte ntrac�•tor:
IF
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't
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
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, 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:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Len
Lender's Address
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty B perjury one of the following declarations:
I have and will maincain a certificate of consent to self -insure for workers'
compensation, as provided for oy Section 3700 of the Labor Code, for the performance
of the work for which this perp- it is issued:
I have and will maintain workers' compensation. insurance, as required by
SI!
on
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 Labor Code, I shall forthwith
comply with those revisions.
'Date: !: _A.Pp` liicc t:
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UN L,
AND SHALL SUBJECT AN EMPLCYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND D01LARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES ASPROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is herby made to the Building Official fora permit subject to
the conditions and restrictions yet 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 applica:ion , the owner, and the applicant,. each agrees to, and
shall defend, indemnify and hol I 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 day: from date of issuance of such permit, or cessation of
work for 180 days will subject p-2rmit 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 enter upon the
above-mentioned property for i ispection purposes.
Uak e: Sign ature,(Applicant.orA nt):
_i
'FINANCIAL
t W DESCRIPTION'
ACCOUNTbX
a PAID
AMOUNT F PAID'DATEE,
t.:QN.ti.r,,
a_ wx u
BSAS SB1473 FEE
101-0000-20306
0
$1.00 $1.00 7/26/16
` r p' PAID BY
METHOD
x PRECEIPT# r F CHECK #� w CD BY
LT
g
g�*�
DESERT POOLS CONSTRUCTION
CASH
R17394 " RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
a '¢ } `DESCRIPTION :`
t' ACCOUNT r
QTY:
AMOUNT
44 PAID'
PAID
-F .S ek �' - .. Iq P
,:4 eY..
-DATE;
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
7/26/16
j
PAIDyBYfCHECK
4v—
#
DESERT POOLS CONSTRUCTION
CASH
R17394
RSE
DESCRIPTION x�KACCOIINT�,Z
"AMOUNT,
PAID
PAID DATE!
_
CfTY`
'
DEVICES; FIRST 20 PC
101-0000-42600
0
; $24.17
$24.17
7/26/16
AID BY
S'�a` 4 FmY'{4`
4WETHODda� *,
t
FZ'at`C
RECEIPTS# F
S
-CHECK #
CLTDBY�;
, y r.
F
ay y
.t,.`
E
DESERT POOLS CONSTRUCTION
CASH
R17394
RSE
Total Paid for ELECTRICAL: $48.34 - $48.34 '
.Rp
t'-.-. ?6�aaf .�y.
DESCRIPTION
,'€. 3 t'$'
;€£n
QTI!
sAMOUNTy
aPAID#
PAID:,DATE
r?s �,�'ACCOl1NT{'
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$181.29
7/26/16
4 - `PAID BY � ����p* ��� ��
� '� METHOD
k, 7777-97 77 777
RECEIPT # � k
#
� CLTD BY �g
, 4�
.. �. � � �
DESERT POOLS CONSTRUCTION
CASH
R17394
i.
RSE
DESCRIPTION:ACCOUNT`
TY
` AMOUNT
PAID '
PAID;DATE�
Q .
+.s..
,
SWIMMING POOL/SPA PC
101-0000-42600
0'
$98.62
$98.62
7/26/16
<
{ � PAID'BY
METHOD
€Y r
CLTD BY
a s; ,:g
.�
a �.� ��tv!
;RECEIPT#
CCHECK#1
61
"
DESERT POOLS CONSTRUCTION
CASH
R17394
RSE
Total Paid for POOL / SPA: $279.91 $279.91
•
Description: JHON BURNS / POOL REMODEL
Type: POOL
Subtype: Status: ISSUED
Applied: 7/21/2016 RSE
Approved: 7/26/2016 DCL
Parcel No: 775330015 Site Address: 54899 WINGED FOOT LA QUINTA,CA 92253
Subdivision: TR 29121
Block: Lot: 15
Issued: 7/26/2016 RSE.
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Voluation: $12,000.00
Ormpanry Type: Construction Type:
Expired: 1/22/2017 RSE
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: EXISTING BOULDERS W/ NEW WATER FALL AT EXISTING POOL, AND BBQ AT REAR YARD. 2013 CALIFORNIA BUILDING CODE.
CONDITIONS
Printed: Tuesday, July. 26, 2016 1:50:32 PIA 1 of 3 •, ,
• ' SYSTEMS
DESCRIPTION
ACCOUNT QTY
AMOUNT
PAID
PAID""DATE
;RECEIPT #
CHECk # ' METHOD
PAID BY CLTD
BSAS SB1473 FEE
101-000040306 0
$1.00
$1.00
7/26/16
R17394
CASH
DESERT POOLS
RSE
CONSTRUCTION.
Total Paid for BUILDING STANDARDS ADMINISTRATIO.N
$1.00
$1.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17.
$24.17
7/26/16
R17394
CASH
DESERT POOLS
RSE
CONSTRUCTION
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
7/26/16
R17394
CASH
DESERT POOLS
RSE
CONSTRUCTION
Total Paid for ELECTRICAL:
$48.34
$48.34
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$181.29
7/26/16
R17394
CASH
DESERT POOLS
RSE
CONSTRUCTION
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$98.62
7/26/16
R17394
CASH
DESERT POOLS
RSE
PC .
CONSTRUCTION.
Total Paid for POOL /'SPA:
$279.91
$279.91
INSPECTIONS
Printed: Tuesday, July 26, 2016 1:50:32 PM 2 of 3
• SYSTF.iv1S.
2ND BLDG NS (1 I CLAYTON 17/26/2016 I 7/28/2016 I 7/26/2016 I APPROVED I
Printed: Tuesday, July 26, 2016 1:50:32 PM 3 of 3
cR?W.'yS'TrmS'
Bin ##
pity of La Quinta
Building 82- Safety Division
Permit #/ 78-495 Calle Tampico
La Quinta, CA 92253 _ (760) 777-70 i 2
6 PQL -P)'O q Building Permit Application and Tracking Sheet
Project Address: '"� C .� Owner's Name: -'��,
A. P. Number:
�IJ-,J�
Address: -31
Legal Description:
City, ST, Zip: a U l v^. r 4, t?�
Contractor:
�
S vis Y�,
leP h n S� 2
7 6
Address: l
Project Description: .e�,�, -.
City, ST, Zip: T-0- 7L G Ll9-
`220 (
-
Te leh on:
p d 2 �'
State Lic. #.: G y
City Lie. #t
Arch., Engr., Designer: .
Address:
City, ST, Zip;
Telephone:
coon Type: Occupancy:
.State Lic. #•
ect dd'n Alter' Repair. Demo
ProJ nP (circle one):. • New A
Name of Contact'Person: � U ✓�l
Sq. Ft.:
# Stories
#Units:
Telephone # of Contact Pers n:766 S 78-, 6^Lg
Estimated Value of Project: �
APPLICANT: DO NOT WRITE BELOW THIS LINE
li Submittal Req'd Recd TRACKING . PERMIT FEES
Plan Sets
Plan Check submitted
Item
'Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Clieck Balance.
Title 24 Cates.
Plans picked up
Conswuctiod
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for correclionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.T1.0
Ii.O.A. Approval
Plans resubmitted
Grad.mg
IN IfOUSE:-'
'"' Review, ready for correctionstissue
Developer Impact Fee
Planning Approval '
Called Contact Person
A.1-P.P.
Pub. \Vks_ Appr
Date ofpermit issue
School Fees,
Total Permit Fees
07/21/2016 THU 00:00 FAX 2001
*********************************
*** FAX ACTIVITY REPORT TX/RX ***
ST.
TIME
DESTINATION ADDRESS
NO.
COMM.
MODE
PGS.
RESULT
*07/01
07:49
UNKNOWN
6952
AUTO RX
1
OK
00'41
*07/01
15:22
858 381 6197
6953
AUTO RX
ECM
1
OK
00'49
*07/05
07:10
877.
270
6185
6954
AUTO RX
ECM
1
OK
00'45
*07/05
07:52
877
551
6790
6955
AUTO RX
ECM
1
OK
00'29
*07/05
10:12
877
270
6185
6956
AUTO 'RX
ECM
1
OK
00'29
*07/06
06:06
877
270
6185
6957
AUTO RX
ECM
1
OK
00'27
*07/06
06:17
877
270
6185
6958
AUTO RX
ECM
2
OK
00'42
*07/06
08:28
3102757104
6959
AUTO RX
1
OK
00'51
*07/06
08:42
3102757104
6960
AUTO RX
1
OK
00'51
*•07/07
13:44
12055999884
1389
TX
ECM
1
OK
00'18
*07/08
12:50
2
1398
TX
'0
NG'
00'00
0
#018
*07/11
08:02
UNKNOWN
6961
AUTO RX
ECM
1
OK
00'26
*07/11
08:11
877
551
6790
6962
AUTO RX
ECM
1
OK
00'29
*07/11
09:38
877
270
6185
6963
AUTO RX
ECM
1
OK
00'24
*07/11
10:37
2015031666
6964
AUTO RX
ECM
1
OK
00'42
*07/11
13:43
7603451922
6965
AUTO RX-
ECM
1
OK
01'19
*07/11
18:01
UNKNOWN
6966
AUTO RX
ECM
1
OK
00'26
*07/12
07:56
877
270
6185
6967
AUTO RX
ECM
1
OK
00'26
*07/12
10:26
UNKNOWN
6968
AUTO RX
ECM
1
OK
00'34
*07/12
10:28
UNKNOWN
6969
AUTO RX
0
NG
00'40
0
*07/12
13:14
UNKNOWN
6970
AUTO RX
ECM
2
OK
00'33
*07/13
06:10
877
270
6185
6971
AUTO RX
ECM
2
OK
00'47
*07/13
06:40
877
270
6185
6972
AUTO RX
ECM
1
OK
00'32
*07/13
07:44
866 212 4132
6973
AUTO RX
1
OK
00'45
*07/13
13:36
UNKNOWN
6974
AUTO RX
ECM
8
NG
02'00
8
*07/13
13:40
UNKNOWN
6975
AUTO RX
ECM
5
OK
02'32
*07/13
13:46
UNKNOWN
6976
AUTO RX
ECM
11
OK
02'53
*07/13
15:43
9516992965
6977
AUTO RX
ECM
4
OK
00'50
*07/14
08:32
866 212 4132
6978
AUTO RX
1
OK
00'40
*07/14
08:34
866 212 4132
6979
AUTO RX
1
OK
00'45
*07/14
08:37
888
388
3044
6980
AUTO RX
ECM
1
OK
00'25
*07/18
08:20
877
551
6790
6981
AUTO RX
ECM
1
OK
00'27
*07/18
10:51
877
270
6185
6982
AUTO RX
ECM
1
OK
00'27
*07/19
08:28
UNKNOWN
6983
AUTO RX
ECM
1
OK
00'23
*07/19
08:35
UNKNOWN
6984
AUTO RX
ECM
1
OK
00'37
*07/19
09:43
760 601 3988
6985
AUTO RX
ECM
1
OK
00'19
07/20
06:41
877
270
6185
6986
AUTO RX
ECM
1
OK
00'44
07/20
10:04
UNKNOWN
6987
AUTO RX'
ECM
1
OK
00'23
07/20
14:01
919373246577
1465
TX
ECM
2
OK
01'03
07/20
14: 36
UNKNOWN
16988
1 AUTO RX
1 JOK
00' 33
RAISED WALL
AT +24"
+0 ..
9-�x t 5T'IN4.•
BOULDER WATER FALL
WITH SLIDE A +
N Zvi
NEW BBQ AT +36" D
T
r7j: �C 15 T1
EXISTING
POOL EQUIP
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