13-1292 (RPL)P.O. BOX 1504
78-495 CALLE. TAMP.ICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:.
13-0001)1292'..
78252 HACIENDA LA QUINTA
646-280-003- - -
POOL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
13000
Tay"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner.
TIMOTHY M OKEEFE
78252 HACIENDA DR.
LA QUINTA, CA 92253'
Architect or Engineer;
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under.penalty of perjury. that I amJicensed under p"royisionwof Chapter 9 (commencing With
Seaion'7000) of Division 3_of he Business and Professionals Code, and my Licerue.is in full force and effect.
License Class: C53 -C27 LlcNo.
�ensi /:�8g23017
��
I�Date:l Contractor:-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am:exempt from the Contractor'sState LicenseLew'for the
following.reason (Sec. 703].5,: Business and Professions Cade: 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-forthe
permit to file, a,signed'stetement that he oashe is licensed pursuant'to.the provisions of the Contractor's State
License Law IChapter9 (commencingiwith Section ,7000)'pf'Division 3; -of the Business and, Professions Code). or
that he or shil exempt therefrom aril basis for the alleged exemption. Any violation of Section 7031.5 by
any,applicaril a permit subjects the applicant to a<civil penalty oil moreithan five hundred dollars 15500).:
C—) 1, as owner of the property; or`nty employees with;wal their sole compensation, will do.the work, and
the structure is not intendedbroffered forr�sale`(Seo:, 7044,.Business and. Professions Code: The
Contractors' State'UcenseLaw does not apply to an owner of property who builds or improves:thereon,.
and who does the work himself or herself through his or herown employees, provided that the
improvements are not intended or offeredfor sale. lf,,however, the building or improvement is sold -within
onel'year of completion, the owner -builder will have the _burden ofprovingthat he or she did not build or
improve for the purpose of sale.).
('_ 1 1, as owner of the property, am exclusively contracting with licensed contractors fo-construct the.project(Sec.
7044,'Business and Professions Code: The Contractors' State License Law does noD,apply to an owner of
property who builds or improves thereon,'and whocontracts for the projects with a comractorls) licensed
pursuant to the Contractors' State License Law:).
( 1 I am exempt under Sec. , B.&P:C..for this reason
Date:
Owner:
CONSTRUCTION LENDING'AGENCY.
I hereby affirm'under penalty of perjury that:thereis'a.cons_truction lending agency -for 'th_e performance of the
work for which this permit"is issued (Sec. 3097, Civ..C.).
41PERMTr
Contractor:
MCRAE POOL & SPAS
79105 DESERT STREAM DR
LA QUINTA, CA 92253
(76:0)774-6343
Lic. No..: 823:0.17
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 10/09/13
OCT 10 2018
WORKER'S' COMPENSATION DECLARATION
I hereby affirm under pall perjury one of thelfollowing declarations:
_ I'ha3e and will maintain:a certifjppte of consent to self -insure for'workers' compensation,.as provided
for by Section 3700_ of the Labor Code, for the performance of rk fo
theswor which this permit is
issued.
I have and will maintain workers''comperisation insurance; as,reQuil by Section.3700 of the Labor
Code, for ths'performaril the work for which this permit is. issued. My workers' compensation
insurance carrier and policy, numbenare: -
Carrier EXEMPT Policy,Number EXEMPT
I certify that, in'the performance of the -work forwhich this perniit:is issued,=1 shall not amploy 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 Cafe, I forthwith calm 1 ` ose;provi§ions.
yffate�
Applicant:
WARNING: FAILURE To SECURE WORKERS' COMPENSATION'COVERAGE IS UNLAWFUL, 'AND SHALL
SUBJECT AN,EMPLOYER'TO CRIMINAL PENALTIES AND�CIvII FINES UP TO ONE.HUNDRED THOUSAND
DOLLARS (81o0,o00). IN ADDITION TO THE COST oF'COMPENSATICM, DAMAGES AS PROVIDED FOR IN
SECTION,VO&OF'THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the,Diractor of Building and Safety fora permit subject to the.
conditions and•restrictions set fortk.on this application.
1'. Each;person upon whose behalf this,application, it made, each person at. whoserequest and for
W. hose benefit wall performed _under or pursuantto any Permit issued as a result, of this application,
the owner, andtha applicant, each agrees to, and shall defend, indemnify and, hold harmless.the City
of La Quinta, its officers, agentsand employeestforany act or omission related to the work being
performed under or.following issuance of this permit.
2. Any,permitissued :as a resuK.of this application,becomes'nulland'void if work is not commenced,
within 180. days fromAateofIissuance of such,permit,'or cessation of work forl8o days will subject
permit to. cancellation.
I certify that',I have. read.this-application and state that the above, information incorrect. I-agree,to�comply with all
city and din
couil ordinances andstate laws,relatiri toibuilding construction; and'hereby-authorize re r - -
of this county to enter upon the.above-mentioned property for ' ction purpo
v
Date:/10k?� Signature (Applicant or Agent):- —
Application Number . . . . 13-00001292
Permit POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
.Expiration Date 4/01/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
178.75-
Permit . . . PLUMBING 2013
Additional des.c .
Permit Fee . . . . 11.-92 Plan Check Fee
.00
Issue Date . . . . 'Valuation . . .
. 0
'Expiration Date 4/07/14
Qty Unit Charge. Per
Extension
1.00 11.9200 LS PLBG GAS SYS., 1-4 OUTLETS
11:9.2
Special Notes and Comments
NEW SPA CONSTRUCTION - INSTALL NEW SPA
WITH' EQUIPMENT _AND ATTACH 10 L.F. OF' GAS
LINE TO EXISTING GAS LINE FROM PREVIOUS
SPA EQUIPMENT.. BLOCK WALL FOR POOL
EQUIPMENT IS:E.XIS.TIN_G. 2010.CALIFORNIA
BUILDING CODES:.
-_---r Fe - --- _
Other es . . . BLDG STDS ADMIN (SB1473)
,
1.00
_ _
PLAN CHECK, POOL
97.24
PLAN CHECK, PLUMBING
23..83
Fee summary Charged Paid Credited
Due
Permit Fee Total 190.-67 .00 ..00
1-90.67
Plan Check Total 00 .0.0 ..00
.0.0
Other Fee Total 122::07 100 .00
122.07
Grand Total 312.74 .00 .00
312.74
LQPERMIT
Bin;#
City of La - Quinti
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 77740:12
Building Permit Application and Tracking Sheet
PermIt.#
Project Address:
/4AC)'67AIDA X
Owner's Name: .
_79
A. P. Number:
Address: — aR
Legal. Description:
City. ST, Zip: 0
Contractor:AA J)ftoTelephone:
Address: OS s
'Project Description: sS-P'
-City, ST, zips
Tel t f
State-Lic. P : Q.'7 CityLic: #:
Aroh,,Engr., Designer. ( GT .
Address:
City., ST -,,Zip:
Telephone:
State Lica,#:
Construction Type: Occupancy:
Projecttype (circle one): New Add'n Alter Repair Demo
Name of Contact Person: .� C
Sq. Et.:
# Stories:
# Units:
Telephone #;of Contact Person:
Estimated Value of Project: 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount
Structural Cala.
'Reviewed, ready for corrections Plan.Cheek Deposit..
Truss Cala.
Called Contact Person, Plan Check`Balauce
Title24Calcs.
Ptauspicked up Construction
Flood plain plan
Plans .resubmitted Mechanical
Grading plan
2"!,Review, ready forcorrecfiojjfu tC [ Electrical
'Subcoutaetor Inst
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"' Review, ready, for correctionsfissua Developer Impact Fee.
Plannin A • roval
Called Conta t erson A.I.P.P.
Pub. Wks. Appr
Datc. T '
School Fees
F11NG & SAFEW DEP
PPF®
T al Permit Fees
DATE _ _ �YZZ�--
L9
Q
I I
CITY OF LA QUINTA'SUB.-CONTRACTOR LIST
JOB ADDRESS70 :i2s.?.- hWciEt4Df4- N PERMIT NUMBER OWNER iiIC�L�FF BUILDER. _
This form shall be posted on the job with the Building Insnedilon Card at all times in a ees are
- - . : - . conspicuous place. Only persons appearing on this list or their ..uthorized to work
Vhis job.. Any -changes to this list 'must be approved by the Building Division prior to "commencement of Work. Failure toand/or the voidance
comply will result in a stoppage of work
J vulluulg permit. rut each dppicaDle trade, zji InTUFF11JUL1011 MqUeS10.0 Deiow must De. compiezea.
Dy appiicant -(Jn File"isnot an aCeeptabld response.
I Classification CUK,
%i"ntralctb�r* Uc
.,,Trade qpflr&4t Gni eahWh
7.71
Company Name
Clatsiricatidn
(b.g. A. 8, C-9)
License Numbei
(xx9994
Exp. Date
(Xxlxx/xx)
Car'&r Name
(e g. �tsiieFund. CalComp)
Poficy Number
(Format Varies)
Exp. Date
(xx/xxhd4
License Number Exp, Date
(xxxx) 1XXIMC.1XIC1,
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78252 HACIENDA DR
LA QUINTA 92253