BPOL2016-0192-------------------------------------------------- -------------- --------- - - - ---
- --- - =$
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of.perjury that I am licensed under provisions df 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, C10, C29, C53. C27. D12 License No.: 656128
Date: / Z T//7 Contractor: % C-710 1F—Y4'
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).:
U 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.).
(_j 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
WORKER'S COMPENSATION DECLARATION Q
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.
/!?P 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:
Carrier: STARSTONE NATIONAL INSURANCE COMPANY Policy Number:
T10160317
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: /f/jd// /PO4";aea
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.
�Z3 ./7
Date: Signature (Applicant orAgent):/��d/�tT %2�4.La/Ji
4
VOICE (760) 777-7125
"78-495 CALLE TAMPI CO
FAX (760) 777-7011 1
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777=7153 '
�
BUILDING PERMIT
}
Date: 1/23/2017 1
Application Number:
BPOL2016-0191
Owner:
Property Address:
50909 CEREZA .
COVE MODEL LOT 28
APN:
776340028
50909 CEREZA
Application Description:
COVE AT CITRUS / POOL
& SPA
LA QUINTA, CA 92253
W
Property Zoning:
Application Valuation:
$30,000.00
cca
®
Applicant:
Contractor:
o Z Q
TESERRA
TESERRA
CV
P O BOX.1280
P O BOX 1280CL
g
COACH ELLA, CA 92236
COACHELLA, CA 92236
a
(760)389-9222
7
Llc No • 656128
-------------------------------------------------- -------------- --------- - - - ---
- --- - =$
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of.perjury that I am licensed under provisions df 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, C10, C29, C53. C27. D12 License No.: 656128
Date: / Z T//7 Contractor: % C-710 1F—Y4'
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).:
U 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.).
(_j 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
WORKER'S COMPENSATION DECLARATION Q
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.
/!?P 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:
Carrier: STARSTONE NATIONAL INSURANCE COMPANY Policy Number:
T10160317
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: /f/jd// /PO4";aea
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.
�Z3 ./7
Date: Signature (Applicant orAgent):/��d/�tT %2�4.La/Ji
-
i
Date: 1/23/2017
,Application Number:
BPOL2016-0191
Owner:
Property Address:
50909 CEREZA
COVE MODEL LOT 28
APN:
776340028
50909 CEREZA -
Application Description:
COVE AT CITRUS / POOL & SPA
LA QUINTA, CA 92253
Property. Zoning:
°
Application Valuation:
$30,000.00
i
i .
Applicant:
Contractor:
TESERRA
TESERRA
P O BOX 1280
P O BOX 1.280 I i
COACHELLA, CA 92236
COACHELLA, CA 92236 j
(760)389-5222
---------------------------------------------------------------------------------------------
Llc. No.: 6E6128
Detail: POOL & SPA AT REAR YARD WITH 21 LF OF 5 FT HIGH EQUIPMENT WALL. EQUIPMENT SHALL
BE INSTALLED IN ACCORDANCE WITH MANUFACTURER
SPECIFICATIONS. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION.
1
.
PER 2013 CALIFORNIA BUILDING CODE
o
R
DESCRIPTION
'FINANCIAL•• •
ACCOUNT CITY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT CITY
AMOUNT
WALL/FENCE- FIRST 100 LF PC
101-0000-42600 0
$63.33
Total Paid for 3LOCK WALL:
$114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$2.00
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
0. .36
. r ,
Bin # City Of La uIn
�j
-Building &r Safety Division
Per
mi # C'- G P.O. Box 1504, 78-495 Calle TamF.ico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Applicati®n and Tacking Sheet
Project Address: p Owner's Name: v�� -w, b y �-� L 07- '
A. P. Number: Address 0
• - So9�9 Ge~�tz� cd Grlrzus
Legal Description: City, ST, Zip: 1?,U iArm Z Z
Contractor:>;sa= i::n'if
Telephone: RYa .sa:.7 Y ....• Y.
Address: 96 )DD t4ve SH Project Description: r,> 5, PA
City, ST, Zip:
Tele hone:
r�tas�':.• �,� •• s
Req'd
Recd
State Lie. # : ��•� j
PERMIT FEES
City Lie. #;
Plan Sets
-•f-3�o u
Arch., Engr., Designer.
Plan Check submitted
i lol f
Address:
Amount
Structural Cates.
City., ST, Zip:
Reviewed, ready for corrections
Telephone:
State Lie. #:
".�iN:'a! {Nilly. .A ty-+S}•:.:{nw:.. �S
YR:ti-.iFi-YS tiy,.0
`teas
o,. >s:� .:.1� AA�;:
- y •fl if• tY.
�\;Y;< a-"`
4;Y>.<'-. s; ,s•` tsrs,.;;�
Construction Type:
e:
Project type (circle one):
_ Occupancy:
ew Add'n Alter Repair Demo
Name of Contact Person:
o�f—J 14?Aq%,m / Ze Z.
-Sq. Ft.: 3 2
# Stories:
4 Units:
Telephone #,of Contact Person:
-76 D Z" - / 9IV I
Estimated Value of Project:
APP1 Ir`ANIT• nn winr tnromc nm —,— .
H
Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plzn Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
2°" Review, ready for corrections/issue .
Eloctrical
Subcontactor List
Called Contact Person
Plu:mbing
Grant Deed
Plans picked up
S.M.L
H.O.A..Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Reyiew; ready for correctionstissue
Dc -eloper Impact Fee
Planning Approval
Called Contact Person
A,EP.P.
Pub. Wks. Appr
Date• of permit issue
Scho61 Fees
Total Permit Fees