BPOL2017-0056ti
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
I
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPOL2017-0056
Property'Address:
48545 VISTA CALICO
APN:
602190016
Application Description:
PELLO / POOL, SPA, AND EQUIPMENT WALL
Property Zoning:
DALE PELLOW
48545 VISTA CALICO
Application Valuation:
$20,000.00
Applicant:
BLACK DIAMOND POOLS & DESIGN
88-351 AVENUE 58TH #6
THERMAL, CA 92274
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.: 977341
Dater
Cfd , i _ Contractor:' It, k— r.,,IO/ ix%
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; 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.).
(1 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:
\.
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION 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 3700 of the Labor Code, for the performance
of t _ 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9164633
_ 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 provisions.
Date sZ d ApplicantT if TVZ�`1LI C �i�
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. I
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 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.
CONSTRUCTION LENDING AGENCY I certify that I have read this application' and state that the above information is correct.
I.hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances and state lavArelating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city to n e on the
above-mentione property for inspection purposes.
Lender's Name:
Date Signature (Applicant or Agent):
Lender's Address: Ci J
Date:
5/2017
z
Owner:
W
DALE PELLOW
48545 VISTA CALICO
Ls�
a
LA QUINTA, CA 92253
N
G
C
Contractor:p
u
BLACK DIAMOND 1)00
4 ESIGN j
88-351 AVENUE 58TH
#6
U D
THERMAL, CA 92274
�,
Q
C3
(760)619-1362
W
Llc. No.: 977341
0
WORKER'S COMPENSATION 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 3700 of the Labor Code, for the performance
of t _ 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9164633
_ 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 provisions.
Date sZ d ApplicantT if TVZ�`1LI C �i�
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. I
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 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.
CONSTRUCTION LENDING AGENCY I certify that I have read this application' and state that the above information is correct.
I.hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances and state lavArelating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city to n e on the
above-mentione property for inspection purposes.
Lender's Name:
Date Signature (Applicant or Agent):
Lender's Address: Ci J
f
Date: 5/8/2017
Application Number: BP,.OL2017-0056"
Owner:
Property Address: 48545 VISTA CALICO
DALE PELLOW
APN: 602190016
48545 VISTA CALICO
Application Description: PELLO / POOL, SPA, AND EQUIPMENT WALL
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $20,000.00
Applicant:
Contractor:
BLACK DIAMOND POOLS & DESIGN
BLACK DIAMOND POOLS & DESIGN
88-351 AVENUE 58TH #6
88-351 AVENUE 58TH #6
THERMAL, CA 92274.
THERMAL, CA 92274
(760)619-1362
tic. No.: 977341
Detail: POOL AND SPA AT REAR YARD, WITH 17 LF OF EQUIPMENT ENCLOSURE AT SIDE YARD. [DENISE
POELTLER ENGINEERING] ALARMS AND BARRIERS
REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
• -
1
,.
DESCRIPTION ACCOUNT
QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306
0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
SWIMMING POOL/SPA
`•101-0000-42404
0
FINANCIAL, INFORMATION
DESCRIPTION
.
QTY
DESCRIPTION ACCOUNT
QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306
0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
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
r ACCOUNT'
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
M
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Bw� I`! p
Qty Gf L a Quinta
Building &r Safety Division
Permit ,'f 78-495 Calle Tampico
La Quinta, CA 92253 - (760)'777-701,2
Building Permit Application and Tracking Sheet
(lPr•ojectAddress: T5 r I `xe.wner'sName �id
A. P. Number:
Le al Description:
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Tele hone: P
t xC.:)ntractor:
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1yA�dress:Proectescripio:
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qty; ST, Zip:
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C,61.
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,4State-Lic. # :
City Lio
A. -ch., Engr., Designer:
Address:
Cay, ST, Zip:
Telephone-
aneY
Construction Type: Occupancy:
P
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S to Lie. {.
State
Project bP a'cleone • New Add'n Alter Repairai
r Dcmo
Name of Contact Person:
l �-� I/NyfL (0 v-,-_.
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:26
. -9
xr-'timated Value of Project: %Z
760— 2DaO—.
APPLICANT: DO NOT WRITE BELOW THIS LINE
if
Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit '
Truss Calcs..
Called Contact Verson
Plan Check Balance,
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
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd. Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
J
I
Total Permit rep
{ Master Association for Rancho La Quinta -
79-285 Rancho La Quinta Drive
La Quinta CA 92253
t Phone: 760-777-8807 Fax: 760-777-.8961
www.rlgma.com
s April, 212017
Dale & Kerri Pellow V
48545 Vista Calico
} La Quinta CA 92253-
Re:
2253 Re: 48545 Vista Calico -Approval of Submission.
Dear Mr. and Mrs. Pellow, '
The Architectural Committee reviewed your submission for the following:
•
New pool, spa, pavers (Paseo Acker -Stone, color: Malibu Canton), landscape, irrigation, lights and
drains.
r
Your submission as presented, is approved contingent on the following:
• Any damage to the common area caused during this construction shall be repaired by the
Owner to the satisfaction of the Association.
• All work is to be done in accordance with all applicable requirements of governmental entities,
including the City of La Quinta and in accordance with all Homeowners Association
Architectural/Landscape Guidelines and governing documents. .
• If required, a City of La Quinta building permit will be obtained and copy furnished to the
Association prior to commencement of work.
• No other structural changes are approved with this submission.,
Once completed, please submit a "Notice of Completion" and the Association's Architect will schedule
an inspection so we can process your deposit for return.
If you have any questions, please contact the onsite office at 760-777-8807.
Sincerely,
CA&
Jamie Circle '
Architectural & Communications Manager ,
Master Association for Rancho La Quinta