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BPOL2016-0042LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the B ess and Professions Code, and my License is in full force and effect. License Class: C-8 1 • C29 C53 C27 D12 Lice a No.: 656128 Date: j C 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 ($500).: I ) 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 ) 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 ) 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.). Lender's Lender's WORKER'S COMPENSATiAN 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 370C 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 es to become sAbject to the workers' compensation laws of California, and agree that, if I shoul ecome subject to the workers' compensation provisions of Section 3 700 oft Labor Code, I shall forthwith comply with those provisions. Date: /G Applicant: WARNING: FAILURE TO SECURE WORKERS' COLA PENSATION 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to th> 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 =ity 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 appliation 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 cancel ation. I certify that I have read this application and state that the above information is rrect. I agree to comply with all city and county ordinances and state laws relating tdo6uilding construction, and hereby authorize representa:ives of this city to enter upon he above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): 11, VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/5/2016 Application Number: BPOL2016-0042 _ Owner: Property Address: 52245 VIA CASTILE MICHALSKI GROUP APN: 777440010 25 IDLEWOOD RQ Application Description: Property Zoning: DUDUM / POOL REMODEL AND FIRE PIT AT REAR YARD KENTFIELD, CA 92253 r� F Application Valuation: $28,000.00 �u Cr Applicant: Contractor: D N o TESERRATESERRA �,LU P O BOX 1280 P O BOX 1280 Q S o COACHELLA, CA 92236 COACHELL•A,,CA 92236 C) �o (760)389-9222 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Llc. No.: 656128 - - - - - - - - - - - - - - - - - r1 - - - - - - - - - - - - - - - - LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the B ess and Professions Code, and my License is in full force and effect. License Class: C-8 1 • C29 C53 C27 D12 Lice a No.: 656128 Date: j C 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 ($500).: I ) 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 ) 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 ) 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.). Lender's Lender's WORKER'S COMPENSATiAN 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 370C 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 es to become sAbject to the workers' compensation laws of California, and agree that, if I shoul ecome subject to the workers' compensation provisions of Section 3 700 oft Labor Code, I shall forthwith comply with those provisions. Date: /G Applicant: WARNING: FAILURE TO SECURE WORKERS' COLA PENSATION 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to th> 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 =ity 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 appliation 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 cancel ation. I certify that I have read this application and state that the above information is rrect. I agree to comply with all city and county ordinances and state laws relating tdo6uilding construction, and hereby authorize representa:ives of this city to enter upon he above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): 11, DESCRIPTION FINANCIAL ACCOUNT CITY AMOUNT - PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # - CHECK # CLTD BY Total Paid for PLUMBING FEES: $36.26 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE' SWIMMING POOL/SPA PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD RECEIPT.# CHECK# CLTD BY Total Paid for POOL / SPA: $279.91 $0.00 TOTALS:00 Description: DUDU.M / POOL REMODEL AND.FIRE PIT AT REAR YARD Type: POOL Subtype: Status: APPROVED Applied: 4/4/2016 SKH Approved: 4/5/2016 JFU Parcel No: 777440010 Site Address: 52245 VIA CASTILE LA QUINTA,CA 92253 Subdivision: TR 32453 Block: Lot: 10 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $28,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NOTIFIED JULIO RAMIREZ THAT PLAN WAS APPROVED AND PERMIT WAS READY TO ISSUE. Details:. POOL REMODEL AT REAR YARD. EXISTING SPA TO REMAIN, WITH NEW POOL CONSTRUCTED AND ATTACHED PER RETROFIT SYSTEM PROVIDED BY EOR. ADD FIRE PIT AT REAR YARD. EXISTING POOL EQUIPMENT TO REMAIN [DENISE POELTLER ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE OR THE INSTALLATION OF ANY NEW EQUIPMENT. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE. _-_.I Applied to Approved CHRONOLOGY TYPE STAFF NAME ACTION DATE CHRONOLOGY COMPLETION DATE NOTES TELEPHONE CALL JAKE FUSON 4/5/2016 4/5/2016 NOTIFIED JULIO RAMIREZ THAT PLAN WAS APPROVED AND PERMIT WAS READY TO ISSUE. CONDITIONS NAME TYPE' NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT TESERRA P 0 BOX 1280 COACHELLA CA 92236 CONTRACTOR TESERRA P 0 BOX 1280 COACHELLA CA 92236 OWNER MICHALSKI GROUP 25 IDLEWOOD RD I KENTFIELD CA 92253 FINANCIAL INFORMATION Printed: Tuesday, April 05, 2016 2:56:30 PM 1 of 2' CRSYSTEMS DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD -BY BSAS SB1473 FEE 101-0000-20306 0 1 $2.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $2.00 $0.00 BSA: GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $0.00 OUTLETS GAS SYSTEM, 1-4 101-0000-42600 0 $24.17 $0.00 OUTLETS PC Total Paid for PLUMBING FEES: $36.26 $0.00 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 for POOL / SPA: $279.91 $0.00 TOTALS:00 Printed: Tuesday, April 05, 2016 2:56:30 PM 2 of 2 cffmw SYSTEMS B`" # City of La Quinta Building &r Safety Division . . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #I BAW Project Address: 2 Z ys" Owner's Name: U'DU AA A. P. Number: Address: S 2 Y Sa CA mu Legal Description: City, ST, Zip: vl Contractor: iZ � Telephone: Address: Project Description: O O p� City, ST, Zip: 2 23 IU �OOC_ o X ST��J� S •� Telephone: P o . . / State Lic. # : City Lie. Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Cntruct ton Type: Occu acY• State Lic. # ircle one • Project w AdiAlter Repair r Dem 0 Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: O ZS b Estimated Value of Project: U 0 O APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check -submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balar.•ce Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN I10USE:- ''d Review, ready for corrections/issue Developer Impac_ Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fee: RECEIVED APR 0 4 2016 CIT! OF LA QUINTA HIDEAWAY Architectural. & Landscape Variance Request IfYou are requesting a Variance to the approved Design Guidelines, please complete this Variance Requesl form and return to the Hidealvay Owner.v Association office. Submittal Dater `' — Lot h: TIOW Applicant/Company: I -e Se vin- t Property Owner: Hideaway Street Address: To the Design Review Committee & Rideaway Board of Directors: I/We request your approval of the following Variance to the Design Guidelines. yDe c,1h� the speci%tc nuture of_t�our,equest inchnling t/te sire, shape, topuvruphy, location and surruundings of the itenis:or conditions that do not cp,npty rvilh the Design Guidelines.) r hV-P_ l.o(.2e The justification for this variance requist is as follows. (Desc,ibe ilre speciul and ernaordinauy circunrslanc:es that exist on your Lot that withoui this tarianee would deprive this property! of a similar level of e:joyntent and Tr.ce/ithiess as exists• on other Lotc within The Hidecnrar..) Attached are drawings and/or exhibits describing the. scope of the work being .requested and :Fie types of materials to be used (if applicable). I/We understand that Building Permits for modifications are required b}+ the City and that the cost: of ti,e pern,its and raspunsibifity of obtaining the pen -nits and.subsequent inspections will be bomb by us. We understand and agree that any Variance request presented .in the attached,plans must be T. proved, in advance, by the Design Review Committee and the Board of Directors. V6111 _TkjvM Signature & Date of Owner or Representative Printed Property Ov,-ner Mame or ReIxesentative 50955 Avenue 52 Lu iluinra, C.A 92253 l yhone 760.393.5210 l Fay 7G9.:9S.5%3R e►nO TV DEVEWpMrj4f Desibu Review Committee Recommendation: 0 Approval ❑ Denial i# Sections of Guidelines for which variances are requested (list all affected sections): List the extraordinary and/or (mu^suall circumstances on the Lot that warrant the DRC's recormnendaticn of approval OOi LCI i(N' DR.0 Representative Signature Board :Decision: �J Approved 0 Denied .Board .Representative Signature 80955 Acme 52 U Quinta, CA )2253 1 Mone 760.393.52 #0 I Fax 760.393.573")