BPOL2015-024878-495, CALLEJAMPICO Twit 4edfv Q" VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/1/2015
Application Number: SPOL2015-0248 1111111 IIIII IIII IIII Owner:
Property Address: 81646 RICOCHET WAY 51 MCGOWEN JEFF & VICKI
APN: 767630023 81646 RICHOCHET WAY
Application Description: MCGOWEN/POOL AND SPA AT REARYARD LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $20,000.00
Applicant:
MCGOWEN JEFF & VICKI
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Contractor:
JEFF M'C GOWAN CONCRETE
81646 RICHOCHET WAY
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78905 MORNING STAR WAY
LA QUINTA, CA 92253
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LA QUINTA, CA 92253
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(760)200-5138
Llc. No.. 772649
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: C-8 License No.: 772649 i
Date: I L 1 1 1 Contractor
OWNER -BUILDER 6ECLARATION
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).:
( 11, 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.).
( 11, 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 Na
Lender's
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'
comp sation, as provided for by Section 3700 of the Labor Code, for the performance
of tht Pork for which this permit is issued.
&116hoave and will maintain workers' compensation insurance, as required by
Secfthe Labor Code, for the performance of the work for which this permit
is is workers' compensation insurance 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 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: ; �/ / J Applicant: 4A4A (tL=
WARNING: FAILURE TO SECURE WORKERS' O P SATION 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. /) /i /J
Date: �� Signature (Applicant or Agent
G
a / � • a 0
.. A X '; Y s � a .�. zty, •. AY iF 5,�.7',,y3' `�€ _
xa&"2"4fD6SCRRIP�ION ` s �4TY� 'PAID
z� . .. `. AV „ AMOUNT PAIDsDAEr
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $1.00 12/1/15
�+��'�'`"C^ ��C � n
`kPAID BYs A byy METFOD
' a� . �i: �r �� �"d.�"�"Y
RECEIPT #: ' CHEEK # ��GLTD BY
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MCGOWEN JEFF ,& VICKI DEBIT,
R11199 SGU
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
}'* :• t k'$"` F - 5?•l,. M' ry
DESGRIPTION�.
CCOUNT�$
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FAIU
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P?pID,DATE
WALL/FENCE - FIRST 100 LF
301-0000-42404
0
.$47.86_ .
$47.86
12/1/15 „
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x PAID."BYE,:'
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METHOD
,-
RECEIPT#. ,,
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jiffCHECK<LTDBY
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MCGOWEN JEFF & VICKI
DEBIT
R11199
SGU
3 r a5
AMOUNT.h',
x
PAID„
A. I.:�DAfiE
a.DESCRIPTION: µ...:...AC�N�s
qT�
,
.,
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$60.91.
$60.91
12/1/15
o- ',� a > .,rvF �� .�,- ,�3, .mss + �� "i •?
� "} P��` � Y � �
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Guppy .
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110000:632=i
'
MCGOWEN JEFF & VICKI
DEBIT
R11199
SGU
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $108.77
uu`f)ESCRIPTION x
' ACCOUNT
AMO
(fix
AID 1
DAT
�T.:.
.�..
rPAID
SWIMMING POOL/SPA
101-0000-42404
0 $181.29
$181.29
12/1/15
�;PAYID BY y �
MET ODS
R EIPTs#
jw
C EEK #
ITA BY
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F
'MCGOWEN JEFF & VICKI
DEBIT
R11199
SGU
`.v DESCRY TIONx�CCO
NT��
�QT
�. � f.
AMOUNT:
p'4'.�. F4r
� AID
P
},
SWIMMING POOL/SPA PC
101-0000-42600
0
$98.62
$98:62
12/1/15
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METHOD.
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CLTD BY
MCGOWEN JEFF & VICKI
DEBIT
R11199
SGU
Total Paid for POOL / SPA:: $279.91. $279.91
•
Description: MCGOWEN/POOL AND SPA AT REARYARD
Type: POOL Subtype: Status: APPROVED
Applied: 11/30/2015 MFA
Approved: 12/1/2015 LUR
Parcel No: 767630023 Site Address: 81646 RICOCHET WAY LA QUINTA,CA 92253
Subdivision: TR 31202-1 Block: Lot: 23
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $20,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ACTION DATE
Details: POOL AND SPA AT REAR YARD [DENISE POELTLER ENGINEERING] THIS PERMIT DOES INCLUDE 6 LF OF EQUIPMENT ENCLOSURE
WALL. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
Printed: Tuesday, December 01, 2015 3:31:35 PM 1 of 2
RA.J Lam/ SYS TEIviS
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE STAFF NAME
ACTION DATE
COMPLETION DATE NOTES
TELEPHONE CALL LUIS URIBE
12/1/2015
12/1/2015
SPOKE WITH JEFF, PERMIT IS APPROVED AND READY TO BE
ISSUED.
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
MCGOWEN JEFF & VICKI
81646 RICHOCHET WAY
LA QUINTA
CA
92253
(442)300-2867
CONTRACTOR
JEFF MC GOWAN CONCRETE
78905 MORNING STAR
WAY
LA QUINTA
CA
92253
(442)300-2867
OWNER
MCGOWEN JEFF & VICKI
81646 RICHOCHET WAY
LA QUINTA
CA
92253
(442)300-2867
Printed: Tuesday, December 01, 2015 3:31:35 PM 1 of 2
RA.J Lam/ SYS TEIviS
Printed: Tuesday, December 01, 2015 3:31:35 PM 2 of 2 c
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BYCLTD
s
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
12/1/15
R11199
DEBIT
MCGOWEN JEFF &
SGU
VICKI
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
WALL/FENCE - FIRST
101-0000-42404
0
$47.86
$47.86
12/1/15
R11199
DEBIT
MCGOWEN JEFF &
SGU
100 LF
VICKI
WALL/FENCE - FIRST
101-0000-42600
0
$60.91
$60.91
12/1/15
R11199
DEBIT
MCGOWEN JEFF &
SGU
100 LF PC
VICKI
Total Paid for FENCE OR FREESTANDING WALL: $108.77 $108.77
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$181.29
12/1/15
R11199
DEBIT
MCGOWENJEFF &
SGU
VICKI
CK
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$98.62
12/1/15
R11199
DEBIT
MCGOWEN JEFF &
SGU
PC
CK
VICKI
Total Paid for POOL / SPA: $279.91 $279.91
TOTALS:
Printed: Tuesday, December 01, 2015 3:31:35 PM 2 of 2 c
SYSTEMS
Bin #
..City of La Q uin to
Building 8i- Safety Division
78-49.5 Caffe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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��W"
Project Address: �ij I C �''
Owner's Name: e i„�/ �/�% 7.
A. P. Number:
Address: g16 q
Legal Description:
City, ST, Zip�: R- U 111j - - - A 22 53
r. C �
Z — moZ �'rContract
Telephone:
............:....:................:......::::
Address: (0 L� (02i G w
Project Description:
City, ST, Zip: ft t A NA A 6,ol l q22 3
-� 14 '1 Q k3 &c, IL
le h c
Telephone: ne• W
P ( Q
Z" Z 7
State Lic. # : 77Z (PY if
City Lic.:#.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
ancY
Occupancy:
:Con tr
uction Type: i
U
State teLic. #:
Project type (circle one N dd'n Alter Repair Demoo
Name of Contact Person: [—. F� I�� O LAJ i-\ N
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 7b Q _ q Q —2-0 f b'
Estimated Value of Project: 2- O p p Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
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
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE-.-
'r0. 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
Rancho Santana
HOMEOWNERS ASSOCIATION
ARCHITECTURAL REQUEST FORM AND AGREEMENT
DATE: ! i �Oto� i6 OWNER'S NAME::e.R-e Mcl owa+i
RANCHO SANTANA ADDRESS:I-I
PHONE: '"I� L: 300-2 V1 EMAIL: MGC.�OLI�QYi�AYiL:r of��
BRIEF DESCRIPTION OF CHANGE:
.we, wt 11 do 0corex-/13W Ocr- - 4t4Z-0a0-2i3fk7
Please attach a detailed drawing or blueprint of your plans) and samples of any/all materials being used.
Approval is requested for the above improvement according to the plans attached. The Association will act on this
request and provide written response of decision within 45 days of submission of this request to the Management
office. 1 further understand and agree to the following:
1. No work will be commenced in regards to this project until I have received written approval from the
Association.
2. All work will be done at my expense; all future upkeep will remain my expense; expeditiously once commenced
and will be done in a good workman -like manner by a licensed and insured contractor.
3. All work will be performed in a timely manner to minimize interference and inconvenlence to other
homeowners.
4. 1 assume all liability for all costs associated with this request and for costs associated with any repair to the
common area occurring as a result of implementing this improvement.
S. I will be responsible for the conduct of all persons, agents, contractors and employees who are connected with
this work.
6. 1 acknowledge that Building Permits for home improvements may be required by the City of La Quinta for the
requested change. The cost of permits and responsibility for obtaining them shall be my responsibility.
7. I acknowledge that a decision by the committee is not final and that the Board of Directors may reverse or
modify a decision upon the written appeal of any owner made to the Board of Directors.
8. 1 acknowledge that the Association may require a deposit to be submitted with this application if the following
changes are being requested:
Pool/Spa, Room Addition/Enclosure, Detached Structure/Casita $1000 (refundable deposit)
• Landscaping/major renovation, Patio Decking/Extension $500 (refundable deposit)
I HAVEAND AGREE TO ARCHITECTURAL REQUEST AGREEMENT AS STATED ABOVE
Owner Signature: G Date: 11161012016
FOR OFFICE USE ONLY.
This application was proved (] Disapproved ❑ Conditionally Approved by the Committee on
Notes:
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-71 seep
-Top"
r.�
BUILDING & SAFETY DEPT
APPROVED
FOR CONSTRUCTION 111
ATE.fl//`b"3 By
(D
. . ......... ..... ......
iZ
Zn
-71 seep
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BUILDING & SAFETY DEPT
APPROVED
FOR CONSTRUCTION 111
ATE.fl//`b"3 By
(D
. . ......... ..... ......