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BPOL2017-004778-495 CALLE TAMPICO Ct D �i�NNCl/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPOL2017-0047 Property Address: 78640 ALDEN CIR CIR APN: 604225015 Application Description: GOFF / REMODEL POOL, ADD TANNING SHELF AND NEW EQUIPMENT Property Zoning: Application Valuation: $10,000.00 VOICE (760) 777-7125 s ' 76%T 7-7011 INSPE I' NS (760 7153 I Y) ate: 4/26/2012 Owner: Q o z � KEITH GOFF N o W 92253 ® N _ CD CL_ 1�:: 9 Q U O Z Applicant: Contractor: J B POOLS J B POOLS CD 45945 LA REINA CT 45945 LA REINA CT 0 LA QUINTA, CA 92202 LA QUINTA, CA 92202 (760)347-4210 --------------------------------------------------------------------------------------------- Llc. No.: 1021763 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.: 1021763 <Date: Contractors �- V — OWN ER-BUILDE 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 Divisiont 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 provided for by Section 3700 of the Labor Code, for the performance of the 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: Carr' r:_§&EMPT Policy Number: °! certify that in the performance of the work for which this permit is issued, I s II n 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. �� Dane-.1fr,�(� Applican1t I V 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 FORIN 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 th ? 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 isuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and sta:e 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 u n the above-mentioned property for inspection.purpeses. Date:_ —( Signature (Applicant or Agent): a Date: 4/26/2017 Application Number: BPOL2017-0047 Owner: Property Address: 78640 ALDEN CIR CIR KEITH GOFF APN: 604225015 Application Description: GOFF / REMODEL POOL, ADD TANNING SHELF AND NEW EQUIPMENT 92253 Property Zoning: Application Valuation: $10,000.00 Applicant:- + Contractor: J B POOLS J B POOLS 45945 LA REINA CT 45945 LA REINA CT LA QUINTA, CA 92202 LA QUINTA, CA 92202 (760)347-4210 --------------------------------------------------------------------------------------------- Llc. No.: 1021763 Detail: ADITION OF TANNING SHELF AND 33 LF OF RAISED BOND BEAM TO EXISTING POOL AND SPA. INSTALLATION OF NEW POOL HEATER AND FILTER EQUIPMENT AT SIDE YARD. [POOL ENGINEERING INC) THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE. a r FINANCIAL •• • 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 ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $299.3 t , 0 -a C Bin #. City of La Quinta ' Building 8F Safety Division Permit #{ - 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Budding Permit Application and Tracking Sheet � 30wncr's Name: rProject Address: .P+1 n7t( A. P. Number: Address: l _ Legal Description: qty, ST, Zip: U �{� n aa i' Contractor: n =TeP le ho e. ,Address: q t oject Description: ,City, ST, Zip: � � Vq C� � C, Tele P hon e• S&V LA 7-0 '11"' MIMMOMOMM Gt CA16tn .State Lie. # : r - 'City Lie. �: Ach.,'Engr., Designer: _ Address: lie City, ST, Zip: Telephone: MEMO=roJState- an Occupancy: ontru ction Type: Y ,. ic# P'ecttYP circle one • New Add'n Alter ReP air Demo. Name of Contact Person: ,e Telephone # of Contact Person: ►�� _ — Sq. Ft.: # Stories: # Units: �,� o a 4Estimated Value of Project: < APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. ReviciVed, ready for corrections Plan Check Deposit Truss Calcs.. Called Contact Person 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 Gran( Deed Plans picked up S.M.I. I-I.O.A. Approval Plans resubmitted Grading IN 110USE:- ''d Reyierv, ready for correctionsfissuc Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees I BPOO-2 ACORa� CERTIFICATE OF LIABILITY INSURANCE. DATE 0212 012 0 1 YY, 02!2012017 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(les) must have ADDITIONAL INSURED provisions or 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 916405-0333 Co CT Kevin David Burke NA Burke Insurance Services 8297 Rural Estates Lane PHONE 916405-0333 FAX916-6824420 (AIC, No, Ext): (A/C, No): AImRESS: burkeins@comcast.net Sacramento, CA 95828-6674 Kevin David Burke 02/15/2018 EACH OCCURRENCE $ 1,000,000 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Associated Industries Ins. CO. 23140 INSURED J B Pools INSURER B: State Compensation Ins.Fund 35076 Jose Blancarte 45945 La Reina Court -INSURER-C: PRODUCTS- COMP/OP AGG $ 2,000,000 La Quinta, CA 92253-7239 INSURER D: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AURRTEEOS ONLY AUTNNOppSWyy EEpp AUTODSONLY A�TOSONLY INSURER E: INSURER F: 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 INSD SUB WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM1DD/YYW LIMITS A X COMMERCIAL' GENERAL LIABILITY CLAIMSMADEOCCUR X Owner/Cont Prot. 8S1045023 02/15/2017 02/15/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED ren ce) $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 1:1 j98T LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AURRTEEOS ONLY AUTNNOppSWyy EEpp AUTODSONLY A�TOSONLY COMBINED SINGLE LIMIT Ea accicent $ BODILY NJURY Per erson $ BODILY INJURY Per accident $ (Aoaardent AMAGE $ []EXCESS UMBRELLA LIAB LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ :DEC RETENTION $ $ B WORKERSION O EMPLOYERS COMPENSATION Y r N ANY PROPRIETORIPARTNERIEXECUTIVE gFFICERIMEMBEER EXCLUDED? (Mandatory in tJH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A 9205118-2017 02/18!2017 02/18/2018 X PEP.LITE OTH- STAT ER E.L. EACA ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ INCLUDED E.L. DISEASE- POLICY LIMIT $ INCLUDED DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER rANrFI I ATInN ACORD 25 (2016103) ©1988-2015 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN J B Pools ACCORDANCE WITH THE POLICY PROVISIONS. 45945 La Reina Court AUTHORIZED REPRESENTATIVE La Quinta, CA 92253-7239 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD e"aaaaem ,r ur T MFRS 4 1 T pwad4 45WAW9� de emde&a I/d4e • 1021763 --------------------------------------------------------------------- ------ Gas Meter - ------------ ----------------------------------------------------- - ----- ; Tera & Keith -- ------------------ -------------------------- 78-640 Alden Court La Quinta CA 92250 15' - ----------------------------- ------------- e sheer 7' SCALE 1/8" = 11FT New Tanning sh if 4', E1, hl h wall '. Approx 400 ! - new concrete --------------------- CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR R CONSTRUCTION DATE VZ� Owner: Tera & Keith Goff Address: 78-640 Alden CT City: LA QUINTA Phone: 760 250-3647 State: CA Zip: 92253 1T v Ili