BPOL2016-0003LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 916827
Date: �_`���K� 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, 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:
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
(760)625-2512
Llc. No.: 916827
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=ekorwhich this permit is issued.
ave and will maintain workers' compensation insurance, as required.by
Se 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: _ 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 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: Applicant: c
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 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 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 upon the
above-mentioned property for inspection purposes.
c --
Date: Signature (Applicant or Agent):
� III'lllll'llllll,llll
,,
C�
17
VOICE (760) 777-7125)
A-495 CALLE TAMPICO
V
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/11/2016.
Application Number:
BPOL2016-0003
Owner:
Property Address:
55290 CHERRY HILLS
DONALD JEANS
APN:
Description:
775170030
JEANS /POOL SPA FIRE
PIT BBQAND COURTYARD WATER FEATURE
2300 DOBBINS LNApplication
IRVING, TX 92253
FN!�E�rlo.
Property Zoning:
Application Valuation:
$33,000.00Applicant:
Contractor:COMPETITIVE
WEST POOL
CONSTRUCTION
COMPETITIVE WEST POOL CONSTR I
P O BOX 5865
P O BOX 5865
rn
LA QUINTA, CA 92248
LA QUINTA, CA 92248
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 916827
Date: �_`���K� 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, 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:
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
(760)625-2512
Llc. No.: 916827
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=ekorwhich this permit is issued.
ave and will maintain workers' compensation insurance, as required.by
Se 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: _ 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 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: Applicant: c
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 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 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 upon the
above-mentioned property for inspection purposes.
c --
Date: Signature (Applicant or Agent):
FINANCIAL • a
'DESCRIPTION :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
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
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
QTY
AMOUNT
PAID
PAID DATE
SWIMMING POOL/SPA
101-0000-42404.
0
$181.29
$0.00
PA16 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
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER FEATURE
101-0000-42404
0
$181.29
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY-
AMOUNT
PAID
PAID DATE
WATER FEATURE PC
101-0000-42600
0
$98.62
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for POOL / SPA: $559.82 $0.00
TOTALS: $646.42 $0.00
Description: JEANS / POOL SPA FIRE PIT BBQ AND COURTYARD WATER FEATURE
Type: POOL Subtype: Status: UNDER REVIEW
Applied: 1/8/2016 SKH
Approved:
Parcel No: 775170030 Site Address: 55290 CHERRY HILLS LA QUINTA,CA 92253
Subdivision: TR 25397 Block: Lot: 30
Issued:
Lot Sq Ft:.O Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $33,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: POOL, SPA, FIRE PIT, BBQ AND COURTYARD WATER FEATURE. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH
MANUFACTURER SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013
CALIFORNIA BUILDING CODE.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESS1
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
COMPETITIVE WEST POOL
CONSTRUCTION
P 0 BOX 5865
LA QUINTA
CA
92248
CHRIS@COMPETITIVE
WESTPOOLS.COM
CONTRACTOR
COMPETITIVE WEST POOL
CONSTRUCTION
P 0 BOX 5865
LA QUINTA
CA
92248
CHRIS@COMPETITIVE
WESTPOOLS.COM
OWNER
DONALD JEANS
2300 DOBBINS LN
IRVING
TX
92253
Printed: Monday, January 11, 2016 9:20:06 AM 1 of 3CRNAJF
SYSTEMS
Permit Details PERMIT NUMBER
City of La Quints BPOL'P201�6!0BC13
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
Printed: Monday, January 11, 2016 9:20:06 AM 2 of 3 J -
SYSTfnAS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT•#
-
CHECK #
METHOD
PAID BY
BY
BW 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
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.
WATER FEATURE
•101-0000-42404
0
$181.29
$0.00
WATER FEATURE PC
101-0000-42600
0
$98.62
$0.00
Total Paid for POOL / SPA: $559.82 $0.00
TOTALS:.4. • 00
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
Printed: Monday, January 11, 2016 9:20:06 AM 2 of 3 J -
SYSTfnAS
ATTACHMENTS
Printed: Monday, January 11, 2016 9:20:06 AM 3 of 3 fl srsrcMs
Bin #
City o.f La Quinn
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1�j yrj�'� pj 10
Project Address: 5S 2`(01 L,L Owner's Name:
A. P. Number:
Address: Z O �-�l U-1
Legal Description:
City, ST, Zip: J nu
Contractor: _ J/
Telephone:
Address: PO S0)( 5965
Project Description:
City, ST, Zip: CA, 92-L pr(L - � - JI%
Ties
Telephone: 625-- asr z -
State Lic. # :%(rJ�p��-
City Lic.#: joyyO3j
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction.TyOccupancy:
Project type (circle one -New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: C 14)z
— Sq. Ft.:
#`Stories:'
`# Units:
Telephone # of Contact Person
_S -] Estimated Value of Project: u
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACE NG PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
Znd Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"' Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
r
PGA WEST.
RESIDENTIAL ASSOCIATION, INC.
February9, 2015 41tvv" tin ,
Mr. Donald Jeans
2300 Dobbins Lane�'� , 1(d d54q
Irving, TX 75063rqogr
Re: Custom Home to be built
Dear Mr. Jeans, -
Page 1 f2
Ef M4,
6wrnit&—,
The Architectural Committee has reviewed your final submittal of drawings plan checked and approved
by the City of La Quinta. The proposed custom home and related site development is as shown on
submittals inclusive of a color board and drawings submitted by Andrzej W. Weber Architect. Sheets:
Title Sheet & Sheet 2 dated 6/18/14; G1 & G2 dated 6/16/14; 3, 4, 5, 6, 6-1, 7, 8, 9, 11, 12, 13, 14, 15, 16,
17, 18, 19, 20, 21, 22, 23, 24 & T-24 dated 10/31/14; GN, GD, S-1, S-2, SD -1, SD -2 & SD -3 dated
6/9/14; HFX1 & HFX2 dated 11/1/13; G1 & G2 dated 10/10/14; A-1 & A-2 dated 1/25/15. The project is
acceptable in accordance with the Architectural Guidelines and the Association's CC&R's.
The following comments and/or requirements are pertinent to the execution of this project:
1. Provide the HOA with a copy of the city permits for pool/spa, site walls, and street work.
2. The review of the mailbox is based on design shown on elevation.
3. Contact the HOA prior to starting the foundation to verify setbacks.
4. The HOA recommends a chain link fence with windscreen to prevent loose debris and materials
from blowing into street and lake.
5. The homeowner and contractor should review the Custom Home Guidelines in reference to the
various schedules, milestones and inspection requirements.
6. The project time period is 9 months.
7. The -Association is not. responsible- for locating easements and underground utilities on the site.
The lake transfer pipe easement is to be marked and, if necessary, protected.
8. The contractor and homeowner must make provisions throughout the project for traffic control to
prevent traffic disruption and accidents. The construction employee parking and vehicles must
park on one side of the street.
9. The contractor is not allowed to stockpile any material, equipment or construction debris in the
street. All debris must be cleaned up daily.
10. The owner and contractor must maintain a dust free construction site to avoid a project stop notice.
If the vacant adjacent lot is used, a letter from the lot owner must be provided. Any encroachment
onto the adjacent is to be repaired. Watering the lot for dust may also require rock transition areas
at curb. Dirt on street should be broom cleaned before washing.
Page 2 of 2
11. The street gutters cannot be used for concrete wash out and the contractor is responsible for
keeping the gutter clear and free of debris.
12. All exterior house and yard lighting is to be compatible with the nightscape and not cause
problems for the adjacent neighbors and is subject to review after installation.
13. The HOA will, with the homeowners' permission, excavate the west section of lake transfer pipe
and cover with concrete for protection. Utility contractor's excavation in vicinity of pipe within or
outside the easement, including the street, to be careful and notified.
14. The pool. landscape. irrigation. yard lighting and paver/hardscape are pending a submittal and
review.
15. Before ANY excavation occurs it is mandatory that the contractor and/or the owner meet with Bill
Bobbitt. Landscape Manager and Steve Herthel. Architectural Committee Chair, as well as contact
Dig Alert and locate all underground utilities.
16. All setbacks, height limitations, equipment and new utility locations are to be per city and HOA
requirements. --
17. Submittals of details and finishes of the site walls, paved system and pool/spa are pending review.
18. Upon completion of the project, the homeowner is required to provide a signed copy of the city
inspection card and the Contractor Certification letter (enclosed).
19. ALL insurance certificates must be current and inclusive of all Association requirements. The
certificate must state that the Association is named as Additionally Insured and is Certificate
Holder. Additionally, the certificate that we have does not include Auto Coverage and states that
the liability policy expires March 25, 2015. Please provide proof of auto insurance.
We reserve the right to make a final inspection of this change to make sure that it matches the original
request. An approval is based only on the aesthetics of your proposed plan and should not be taken as any
certification as to the construction worthiness or structural integrity of the proposed change.
We appreciate your cooperation in submitting this request for approval. If I may be of further assistance,
please contact me at the HOA office, (760) 771-1234, Extension 19.
Cordially,
Kelly McGalliard
Operations Manager
For the Architectural Committee
KM/bvf
Enc. 1
Cc: Architectural Committee
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JEANS RESIDENCE CA -C-53 # 916827 COMPET/T/VE
.55-290 CHERRY HILLS 78-150 CAVE TAMPICO SUITE 101
LA QUINTA LA QUINTA. CA 92253 YY EST
760.6252512
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