BPOL2017-0128LICENSED 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- C53 License No.: 614611
: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
($500).:
(-1 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.).
Lender's
Lender's
WORKER'S COMPENSATmN 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 3700wf the Labor Code, for the performance
of the work for which this permit is issued.
,- Dave 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: WESCO INSURANCE COMPANY Policy Number: WWC325615
I certify that in the performance of tie work for which this permit is issued, I
shall not employ any person in any manner so zs to become subject to the workers'
compensation laws of California, and agree tha-, if I should become subject to the
workers' compensation provisions of Section 3:00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: t 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 applic4tion 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
I certify that Ihave read this application and stare 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 upo he
above -mention d pr perty for inspection purposes.
Date: Signature (Applicant ci Age
TAti
� Q"
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/16/2017
Application Number: BPOL2017-0128
Owner:
Property Address: 53663 VIA DONA
GEIS
APN: 777420019
53663 VIA DONA
Application Description: GEIB / REMODEL POOL
SPA BBQ AND FIRE PIT
LA QUINTA, CA 953
Property Zoning:
i
u
Application Valuation: $50,000.00
Applicant:
Contractor:
MC INTYRE POOLS & SPAS INC
MC INTYRE POOL_ &SPAS INCA -
83-695 AVENUE 45
83-695 AVENUE 45
o
�.
INDIO, CA 92201
INDIO, CA 92201
(760)342-3612
LIC. No.: 614611
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- C53 License No.: 614611
: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
($500).:
(-1 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.).
Lender's
Lender's
WORKER'S COMPENSATmN 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 3700wf the Labor Code, for the performance
of the work for which this permit is issued.
,- Dave 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: WESCO INSURANCE COMPANY Policy Number: WWC325615
I certify that in the performance of tie work for which this permit is issued, I
shall not employ any person in any manner so zs to become subject to the workers'
compensation laws of California, and agree tha-, if I should become subject to the
workers' compensation provisions of Section 3:00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: t 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 applic4tion 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
I certify that Ihave read this application and stare 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 upo he
above -mention d pr perty for inspection purposes.
Date: Signature (Applicant ci Age
Application..Number:
BPOL2017-0128
Property Address:
53663 VIA DONA
APN:
777420019
Application Description:
GEIS / REMODEL POOL SPA BBQ AND FIRE PIT
Property Zoning:
Application Valuation:
$50,000.00
Applicant:
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
INDIO, CA 92201
Owner:
GEIB
53663 VIA DONA
LA QUINTA, CA 9.253
Contractor:
MC INTYRE POOLS & SPAS INC
83-695 AVENUE 45
INDIO, CA 92201
Date: 8/16/2017
(760)342-3612
Llc. No.: 614611
---------------------------------------------------------------------------------------------
Detail: REMODEL POOL WITH SPA, BBQ, AND FIRE PIT AT REAR YARD [JEFFEREY A. COLLINS ENGINEERING) THIS PERMIT [DOES NOT INCLUDE EQUIPMENT
ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILCING CODE.
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY .
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBINGIFEES: $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$103.36
Total Paid for POOL / SPA: $293.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
1 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
0
Bin #
# Stones: #.Units:
Cit/ Of La Qu' inta .
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
t
ect Address: Gr l�
—
Owner's Name:
FAA.. Number:Address:
3 663Ual
Description:
Contractor. C -To t S
Address: — 6q-5
City, ST, Zip:�(( 1/j
S ..
{
S Telephone:
Project Description: f-eymCly 1W SQa
City, ST,.Zip: Q)c0. CI4
020 to 4
Telephone: 70V — . N a_
State Lic. # City Lic: # I S
Arch., Engr., Designer .. .
Address:
City.; ST, Zip:
Telephone:
Construction Type: Occapancy:
Title 24 Calcs.
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ke e Sq. Ft.:
# Stones: #.Units:
Telephone # of Contact Person: U — S' Estimated Value of Project: ) V
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd.
TRACIMG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Calcs..
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plait Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2'" Review, ready for correctionstissue Electrical
Subcontactor List
Called Contact Person Plumbing:
Grant Deed
Plans.picked up S.M I.
H.O.A. Approval
Plans resubmitted Grading
I14 -HOUSE".
''a Reyiew, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person .LP.P.
Pub. Wks. Appr
Date of permit issue Ifta"
School Fees
2017
- _ • "wwi l Y DEVELO-
PI
July 31, 2017
Mr. and Mrs. Robert Geib
901 Jefferson
Bensenville, IL 60106
RE: Lot 36D at 53.663 Via Dona
Remodel: Plan review by Gerry Tarsitano (Golf Club)
Dear Mr. and Mrs. Geib:
This correspondence shall serve as notification that The Hideaway Design Review Committee (DRC)
received additional review comments from Gerry Tarsitano on behalf of the Golf Club. The Club's
comments regarding your most recent plan submittal are as follows:
• No access to the rear yard can be provided on the golf course property
• A construction fence will be required on the rear property line during construc-ion
• All dirt and debris from the demolition and construction must be maintained within the property
boundaries
• No grade changes can extend past the rear Transition Area line
• Any and all damage that may occur to the golf course that require repair will be reimbursed by
the homeowner (including any grade changes, landscape restoration, or irrigation replacement)
Please contact Brook Marshall at 760-219-8057 or by email at DRCFacilitator@g:-nail.com with any
questions or to schedule your Pre -Construction Meeting once a Building Permit has bean obtained.
Sincerely,
THE HIDEA WA Y DESIGN RE VIE W COMMITTEE
Title:
cc: RGeib@geibind.com
EE
Peter Jacobs
DRC File
Date:
Pursuant to Cal. Civil Code, any rejection by the DRC may be appealed to the Board of Directors for the Association_ If you wish to pursue an
appeal, please contact the Association's property manager directly
K*
ei6
At
st%4met
-
663
u:a
0007,
2'Isa-A.
CA
RESI-
EN
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