BPOL2014-10057/8/2014 Building Permit
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PERMIT NO BPOL2014-1005
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78-495 CALLE TAMPICO C&0 U 4 �Cl/
LA QUI NTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
SPOL2014-1005
Property Address:
80221 VIA PESSARO
APN:
777210032
Application
POOL SPA WATER FEATURE
Description:
Property Zoning:
$25,000.00
Application Valuation:
Applicant:
REMBRANDT POOLS & SPA
77564 COUNTRY CLUB DR
LA QUI NTA, CA 92211
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penaltyofperjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and
Professions Code, and my License is in full force and effect.
License,Class: License No.: AEC115
Date.//?, It 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 rea son (Sec. 7031.5, Business and
Professions Code: Any city or county that requires a permit to construct, alter,
improve, demolish, or repair a ny 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 (Cha pter9
(commencing with Section 7000) of Division 3 ofthe 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 anyapplicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(__) I, as owner ofthe 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 orherselfthrough 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 sa le.).
(-__) I, as owner ofthe property, am exclusively contracting with licensed
contractors to construct the project. (Sec. 7044, Business and Professions Code:
The Contra ctors'State License Law does not apply to an ownerofproperty who
builds or improves thereon, and who contracts for the projects with a
contractor(s)licensed pursuant to the Contra ctors'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 perjurythat there is a construction lending
agency for the performance ofthe work for which this permit is issued (Sec.
3097, Civ. C.).
Lender's Nam
View Report
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/8/2014
Owner:
FRANK HALCOVICH
80221 VIA PESSARRO
LA QUI N—A, CA 92253
Contractor:
REMBRAJDT POOLS & SPA
77564 CCIUNTRY CLUB DR
LA QU I N—A, CA 92211
(760)771-.2121
Llc. No.: AEC115
WORKER'S COM PENSATION DECLARATION
I hereby affirm under penaltyofpeiijuryone ofthe following declarations:
_ I have and will maintain a :ertificate of consent to self -insure for
workers' compensation, as provided for by Section 3700 ofthe La bor Code, for
the performance ofthe work for which this permit is issued.
I have and will maintain warkers'compensation insurance, as required
by5ection 3700 ofthe Labor Code, 'orthe performance ofthe workforwhich this
permit is issued. My worke rs'com pens ati on insurance carrierand policy
number are:
Carrier: Policy Number:_
I certify that in the performance ofthe work for which this permit is
issued, I shall not employ any perscn in any manner so as to become subject to
the workers'compensation laws of::alifornia, and agree that, if I should become
subject to the workers'compensatfon provisions of5ection 3700 ofthe Labor
Code, I shall forthwith comply with ::hose provisions.
Dai ? ti' I� Applicant:
WARNING: FAILURE TO SECURE WOR[ERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TOONE HUNDRED THOUSAR'D DOLLARS ($100,000). IN ADDITION TOTHE
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 fora permit
subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalfthis 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 ofthis 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 actor omission related to the
work being performed under or following issuance ofthis permit.
2. Any permit issued as a result of This application becomes null and void if
work is not commenced within 180 daysfrom date ofissuance ofsuch permit, or
cessation ofworkfor 180 days will srobject permit to cancellation.
I certifythat I have read this applica:ion and state that the above information is
correct. I agree to comply with all ci-y and county ordinances and state laws
relating to building construction, an 1 hereby authorize representatives ofthis
city to enter upon the above-mentioied property for inspection purposes,. ---
Da te
urposes.---Dat :'.?,-�( Signature (Applicant or Agent
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