BPOL2016-006878-495 CALLE TAM PICO
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPOL2016-0068
Property Address: 78795 WAKEFIELD CIR
APN: 664431005
Application Description: WEBER / POOL REMODEL - ADD TANNING SHELF
Property Zoning:
Application Valuation: $2,000.00
Applicant:
VAZQUEZ POOL PLASTERING
73-495 BURR OAK TRAIL
THOUSAND PALMS, CA 92276
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: 0-533 `License No.: 1001554
Date::' 1 ! —IU Contractor4z"�t�z,��_
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 bf 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 of 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 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: '
i
Lender's Address: f
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/17/2016
Owner:
MARK WEBER
78795 WALKEFIELD CIR
LA QUINTA, CA E2253
(760)799-1261
Llc. No.: 1001554 - z
--L
WORKER'S COMPENSA-ION DECLARATION '
I hereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certificatle of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
ofth wfrk for which this permit is issued.
X ( have and will maintain workers' c•:)mpensation 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 insuranoe 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 sous to become subject to the workers'
compensation. laws of California, and agree that, if!.>M Id b ome subject to the
workers' compensation provisions of Section 2-70 of a or Code, I shall forthwith
comply with those provisions.
7
Date: r / -At 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 FOF 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 :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 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 cancelbtion.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordirances and state laws re g to building
construction, and hereby authorize representaives of this city toe er on the
above-mentioned property for inspection purposes.
(Date. �Z /. %' Signature (Applicant orA&e ��d�
0
D
Contractor:
r—+
VAZQUEZ POOL PLASTE m
_8
73-495 BURR OM*< TRAI a .
ry
THOUSAND PALMS, CA 7W
CD
o;
C===3
(760)799-1261
Llc. No.: 1001554 - z
--L
WORKER'S COMPENSA-ION DECLARATION '
I hereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certificatle of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
ofth wfrk for which this permit is issued.
X ( have and will maintain workers' c•:)mpensation 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 insuranoe 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 sous to become subject to the workers'
compensation. laws of California, and agree that, if!.>M Id b ome subject to the
workers' compensation provisions of Section 2-70 of a or Code, I shall forthwith
comply with those provisions.
7
Date: r / -At 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 FOF 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 :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 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 cancelbtion.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordirances and state laws re g to building
construction, and hereby authorize representaives of this city toe er on the
above-mentioned property for inspection purposes.
(Date. �Z /. %' Signature (Applicant orA&e ��d�
0
FINANCIAL •• 1
;DESCRIPTION r;R =� ggx T
s s £ j'ACCOIJNT" g� QY , �AMOUNT� PAID"PAIDDATE
BSAS SB1473 FEE 101-0000-20306 0
$1.00
$0.00
A ixx E z PAIDBY,*;.RECEIPT
# `+'
` CHECK #� F " CLTD BY,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
i DESCRIPTIONS
'� ,'�'.-:��xi .:..^r .., :r ^,_? Z �7ib•.Qry
'�" ACCOIJNT� ,5„9
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;`QTYa'AMOUNT
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- t°:Y. 5 xiXN M"6:
"gK PAID , {�'PAIDDATE
3e n , q. -r-} 29a _ .H.�f4
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SWIMMING POOL/SPA
1,0�g1-0000-42404
0..
$181.29
$0.00
Y'a R ty.� i R
say _...ikPAIDkBY4.
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�°: --A000UNT
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AMOUT
.PAID i -s
PAIDDATE�
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
$0.00
PE=c PAID,
�. 'BY i
rvM METHOD
�E,W >,RECEIPT
#qg c �
CHECK #
�CLTD BY i
Total Paid for POOL / SPA:. $279.91 $0.00
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Description: WEBER / POOL REMODEL - ADD TANNING SHELF
Type: POOL Subtype: Status: APPROVED
Applied: 5/17/2016 SKH
Approved: 5/17/2016 SKH
Parcel No: 604431005 Site Address: 78795 WAKEFIELD CIR LA QUINTA,CA 92253
Subdivision: TR 23995-8 Block: Lot: 13
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $2,000.00. Occupancy Type:. Construction Type:
Expired:.
No. Buildings: 0 No. Stories: 0 No. Unites: 0
73-495 BURR OAK THOUSAND CA 92276
Details: REMODEL POOL, ADD TANNING BENCH. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS.
ALARMS AND BARRIERS REQUIRED TO BE INSTALLED'AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
APPLICANT VAZQUEZ POOL PLASTERING
73-495 BURR OAK THOUSAND CA 92276
(760)534-6855
vasquezpoolplastering
TRAIL PALMS
414@gmail.com
CONTRACTOR VAZQUEZ POOL PLASTERING
73-495 BURR OAK THOUSAND CA 92276
(760)534-6855
vasquezpoolplastering
TRAIL PALMS
414@gmail.com
OWNER MARK WEBER
78795 WALKEFIELD CIR LA QUINTA CA 92253
(760)534-6855
a
INFORMATION!`
FINANCIAL INFO t
Printed: Tuesday, May 17, 2016 1:24:01 PM 1 of 2
- SYSTEMS
Printed: Tuesday, May 17, 2016 1:24:01 PM 2 of 2
OpwlYSTEMS
'F
SCRIPT.IONt
C -C
��,;!CHECW#
PA I D- BY, -"Ki
LT
"4
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00. $0.00
BSA:
SWIMMING POOL/SPA
101-0000-42404
0
.$181.29
moo
SWIMMING POOL/SPA
101-0000-42600
0.
$98.62
$0.00
PC•
Total Paid for POOL SPA: '$279.91 $0.60
Printed: Tuesday, May 17, 2016 1:24:01 PM 2 of 2
OpwlYSTEMS
Qin,# .
City. of La Quit] is
Building St Safety Division
78-495 Calle-Tampico
La Quinta, CA 92253 - (760) 777-7012 •
Building Permit Application and Tracking Sheet
Permit #
Project Address: g �� . e-
Owner's Name:. AK qAr Ls,
-A. P. Number:
Address:
Legal Description:_
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Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Thousand Palms, Ca 92276
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