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BPOL2015-0231
'R a 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ' TAtr44Qumrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 13 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/2/2015 Application Number: BPOL2015-0231 Owner: Property Address: 81756 DANIEL DR DAVID AND KATHLEEN KELM APN: 764360028 81756 DANIEL DR Application Description: KELM / NEW POOL AND BUILT IN BBQ LA QUINTA, CA 92253[ZE_-rs,, Property Zoning: Application Valuation: $32,000.00Co Applicant: Contractor:DESERT OUTDOORS INCDESERT OUTDOORS INC78065 MAIN STREET #205 78065 MAIN STREET #20LA QUINTA, CA 92253 LA QUINTA, CA 92253 (760)399-9600LIC. No.: 964474 LICENSED CONTRACTOR'S_DECLARATION I hereby affirm under penalty of perjury that I am licensed rider provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bin ss and Professions Code, and my License is in full force and effect. License Class: C27. C53 License No.: 964474 Da e"_ II t (i' 13 Contractqu� OWNER -BUILDER DEC T10 I hereby affirm under penalty of perjury' that I am empt from the Contractor's State License Law for the following reason (Sgc. 7031.5, usiness and Professions Code: Any city or county that requires a permit to olnstruct, Iter, improve, demolish, or repair any structure, prior to its issuance, also re uire he 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.). (_) 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 Name: Lender's Address: 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 rovided for by Section 3700 of the Labor Code, for the performance of the wor _jc,Wwhich this permit is issued. e and will maintain workers' compensation insurance, as.required by Sectio 00 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: _ Polity 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 as to be rrie subject to the workers' compensation laws of California, and agree that, if.1 sh Id become subject to the workers' compensation provisions of Section 3700 of Labor Code, I shall forthwith comply with those provisions. Date*e , Applic WARNING: FAILURE TO SECURE WO KERS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER 0 CRIMI AL PENALTIES AND CIVIL FINES UP TO, ONE HUNDRED THOUSAND DOLLARS ($100, 0). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PRO IDED OR 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 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. I certify that I have read this application and state that the above infor^}gion is correct. I agree to comply with all city and county ordinances and ting to building construction, and hereby authorize representatives of this city toenter upon the above-mentioned property for inspection purposes. �� Da Signature (Applicant or DESCRIPTION 1 •1• FINANCIAL ACCOUNT QTY 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 QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD RECEIPT•# CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 PAID BY - METHOD RECEIPT # CHECK #• CLTD BY ' Total Paid for ELECTRICAL: $48.34 $0.00 DESCRIPTION. ACCOUNT. QTY AMOUNT PAID PAID DATE SWIMMING POOL/SPA 101-0000-42404 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION 'ACCOUNT ` QTY 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 • 1 • 00 Description: KELM / NEW POOL AND BUILT IN BBQ. Type: POOL Subtype:. Status: APPROVED Applied: 10/19/2015 SGU Approved: 10/20/2015 KKI Parcel No: 764360028 Site Address: 81756 DANIEL DR LA QUINTA,CA 92253 Subdivision: TR 30023-2 Block: Lot: 28 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $32;000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CHRONOLOGY TYPE Details: POOL, SPA, AND BBQ. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. PER 2013 CALIFORNIA BUILDING CODE. -�I Applied to Approved Printed: Monday, November 02, 2015 3:07:13 PM 1 of 2 S YSTf AAS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES CALLED JOHN AND LEFT MESSAGE ABOUT WORKER'S COMP NOTE STEPHANIE GUMPERT 10/19/2015 10/19/2015 BEING EXPIRED returned to stephanie 10 /20 15 CONTACTSCONDITIONS NAME TYPE• NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT DESERT OUTDOORS INC 78065 MAIN STREET LA QUINTA CA 92253 (760)399-9600 #205 CONTRACTOR DESERT OUTDOORS INC 78065 MAIN STREET LA QUINTA CA 92253 (760)399-9600 #205 OWNER DAVID AND KATHLEEN. KELM 81756 DANIEL DR I LA QUINTA CA 92253 (760)399-9600 Printed: Monday, November 02, 2015 3:07:13 PM 1 of 2 S YSTf AAS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # -I METHOD PAID BY CTD t BY BY BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $2.00 $0.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $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 INSPECTIONS PARENT e•. RETURNED REVIEWS STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE KIRK 10/19/2015 10/26/2015 10/20/2015 APPROVED 1ST BLDG NS (1 WK) KIRKLAND Printed: Monday, November 02, 2015 3:07:13 PM 2 of 2 1 SYSTGIv1S LSO k g � E :SNOLLO3ES 1VI2131VW o s 1IHl34 9NIA sMS IOL ,Q VNSV6INNOf yty� s�oz ei'ieas '"°"'�° - b a NVId 311S B CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DA��E w� ® � am awmera si ams co m s r DN K pv m �Z m D m (n r- 0 om a Z m U 1dAONddd lIWN3d Nod 7 b3 e 1, a ... n .,... � ...� � L aPi31 irseQN3031 3'JILa4163M 9NI151X3 l W p 8i1D 663MIL X001 IptM Ol QIIN! W GO Q?LL 9OOI IOIM 6l1[�l¢1 WY. 1�Y 110LL'J W IIDN IOOY MIIM iD�IK IPlti M31 sn ams 111088 Lv - �MOLNOTI. IIY CCOO L�.OIM �.I-•III ""°� x�ua•asurom 'du'LIXII@u - si ams 11V1301143320 U33HS 8921 LE s� A— m�ws� si ams 1IV130 JNIdOO IaUlYld -100d 11111=111-, =III—III- :: si ams 11V13013r V JS Bio # City6f La Quinta BuNing a Safety Division 23� P.O Box 1304,'78-493 Cage Tampico La.Qidnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: '? S (9 I� �� Owner's Name: A. P. Number. Address: Legal Description: Contractor: TF— 'j' City, ST, Zap. L'or du 1 Telephone: -70c...). (paw Project Description: awl,I#J1 Vim— I . Address: 7??(pS city, Sf, zip: l:. F4 V Telephone: .3 State Lie. # : Arra., Bngr , Designer. �� "CihtyLia #: . Address: City, ST, by. Telephone: State Lia #: Construction Type. Occupancy: Project we (circle ono): Now Add'n Alter Repair Deato Name of Contact Person: Sq. FL: # Stories: # Unity Telephone # of Contact Person: 95 —7 35 F,sdmated Value of Projecx 2 c�j7 APPUCANT: DO NOT WRITE BELOW THIS UNE H Submittal Req'd Recd TRACK M PERMIT FEES Plau sets Plan Chetksubmitted Item Amoant Structural CaIes. Reviewed, ready for corrections Plan Check IItpos[t Trus Cake. Called Contact Person Phu► Check 1wanee. Mile 24 Calcs. Plans picked up Conal aWon Flood plain plan Pians resubmitted Mechanical Grading plan 2'! Review, ready for earrectionsame Electrical Subcoatactor List Caped ContactPerson Plumbing Grant Deed Plans pleked up S.A,i.l. . H.O.A. Approval Plans resubmitted Grading , W HOUSE:- Planning Approval "' Review, ready for c milons&sne, Called Contact Person Developer Impact Fee AJ.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees DESEOUT-01 TDELGADO .44cOROn CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10!20/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # OF09643 Desert Empire Ins Services, Inc. 77564 Country Club Drive Suite 401 Palm Desert, CA 92211 CONTACT NAME: tona.delgado@desertempireins.com FAX PHONE 760) 360-470D(AIC, A/c No Ext A/C No : 760) 360-4799 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A: Associated Industries Insurance Co 23140 11117/2014 INSURED INSURERB:American Fire &Casualty Company 24066 . Desert Outdoors, Inc. INSURER C: Benchmark Insurance Company 41394 Desert Landscape Associates, Inc. 78065 Main Street, Suite 205 INSURER D La Quinta, CA 92253 INSURER E INSURER F: GENERAL AGGREGATE $ 2,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I D SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR BLKT ADD'L INSURED AES1032281 00 11117/2014 11/17/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED100,000 PREMISES Ea occurrence $ X MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a JE r LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO' ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ED X HIREDAUiOS X AUTOS BAA (14) 55796911 12/0212014 12/02/2015 COMBINED SINGLE LIMIT S 500,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS S C WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? Y❑ (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below NIA CST5007172 - 10/1812015 10/18/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta 78495 Calle Tampico THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD