BELC2017-00051.
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78-495 CALLE TAMPICO 4
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
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Application Number: BELC2017-0005
Property Address: 53255 EISENHOWER DR
APN:, 774085013
Application Description: D'ANNARESIDENCE/T ER //\\
Property Zoning:
Application Valuation: $750.00
Applicant: JAN 2 0 2ov
CRYSTAL BLUE POOLS AND PATIOS
31166 ORANGE AVENUE CITY OF LA QUINTA
NUEVO, CA 92567 DESIGN AND DEVELOPMENT DEPARTMENT
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. B, C-8. C27 ti se o.: 84 3
t
Date: rL d Contracto
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.).
(� 1, 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/20/2017
Owner:
JESSE D'ANNA
Contractor:
CRYSTAL BLUE POOLS AND PATIOS
31166 ORANGE AVENUE
NUEVO, CA 92567
(951)906-2761
Llc. No.: 846843
WORKER'S COMPENSATION DECLARATION
I hereby affirmunder 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 :)f the Labor Code, for the performance
of the work for which this permit is issued.
_J!�-i-have and will maintain workers' coanpensation insurance, as required by
Section 3700 of the Labor Code, for the perforrt:ance of the work for which this permit
is issued. My workers' compensation insurance carrier and polity number are:
Carrier: SOUTHERN INSURANCE COMPANY Policy Number: OWC1005100
I certify that in the performance of tie 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 thalL if I should become subject to the
workers' compensation provisions of Section 3X00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: I' 20 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 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 applicztion becomes null and void if work is
not commenced within 180 days from date of i:.suance of such permit, or cessation of .
work for 180 days will subject permit to cancel] 3tion.
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 u n the
above-mentioned property for inspection purposes.
Date: —� Signature (ApplicarAr Agent):
Date: 1/20/2017
ti
Application Number:
BELC2017-0005
Owner:.
Property Address:
53255 EISENHOWER DR
JESSE D'ANNA
APN:
774085013
Application Description:
D'ANNA RESIDENCE /TEMP POWER
Property Zoning:
Application Valuation:
$750.00
Applicant:
Contractor:
CRYSTAL BLUE POOLS AND PATIOS
CRYSTAL BLUE POLLS AND PATIOS
31166 ORANGE AVENUE
31166 ORANGE AVENUE -
NUEVO, CA 92567
NUEVO, CA 92567
(951)906-2761
------------------------=--------------------------------------------------------------------
LIc. No.: 846843
Detail: ELECTRICAL TEMP
POWER - INSTALL TEMPORARY POWER FOR NEW CONSTRUCTION.
2016 CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT QTY .1 AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION ,
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$17.73
Total Paid for ELECTRICAL: $43.06
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
TOTALS: $140.33
u
Bin # e
.City of La Quinta
Building a Safety Division
Permit " 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: S 3'L�'LS�Owner's Name:
A. P. Number:
Address: 52..
Legal Description:
City, ST, Zip:
Contractor: Its�b
aS
�Tele hone: -
Address: `17) (� t � l b Z
Project Description:
City, ST, Zip: 7A-71e_s<_, -
TelP e hone: n al
l (7 7
�n S
State Lip. # 3 q
City Lic..
Arch','Engr., Designer:
Address:
City, ST, Zip:
Telephone:
hone:
Con tru tion Type: O ecu ar cy:
Project type (circle one): New Ad A Repair Demo
State 'e ,.
.........:::::::::::>:
::
Name of Contact Person: _ � `
(l avh
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: (
•
Estimated Value of Project: -750 .
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Depos'at
Truss Calcs.
Called Contact Person
Plan Check Balande
Title 24 Cafes.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections. /issue
Electrical .
SubcontactorLisl
Called Contact Person
Plumbing
Grant Deed .
Plans picked up
S.M.I.
II.O.A.. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"'. Review, ready for correetionstissue
Developer Impact'Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. \Vks- Appr
Dale of permit issue
School Fees,
Total Permit Fees