BPOL2017-0022r
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78-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT' DEPARTMENT
BUILDING PERMIT
Application Number: BPOL2017-0022
Property Address:
81905 FOUR SEASONS PL
APN:
767860004
Application Description:
MONTERRA / POOL AND SPA AT REAR YARD
Property Zoning:
Application Valuation:
$14,000.00
Applicant:
1 M N SERVICES INC DBA ARCH BLUE
P O BOX 1215
PALM SPRINGS, CA 92263
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.: 879184
a
Date:
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.).
(_) 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. Q.
Lender's
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/3/2017
Owner:
LA QUINTA HOUSING 1 LLC
27285 LAS RAMS. -1S SUITE 230
MISSION VIEJO, CA 92691
Contractor:
J M N SERVICES INC DBA ARCH BLUE
P O BOX 1215
PALM SPRINGS, C4 92263
(760)327-1533
Llc. No.: 879184
WORKER'S COMPENSATON DECLARATION
I hereby affirm under penalty of perjury one o1 the following declarations:
I have and will maintain a certificate• of consent to self -insure for workers'
compensation, as provided for by Section 370C of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' ccrnpensation 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number:
I certify that in the performance of :he work for which this permit is. issued, I
I not employ any person in any manner so as to become subject to the workers'
pensation laws of California, and agree that, if I should become subject to the
kers' compensation provisions of Section 1100 of the Labor Code, I shall forthwith
ply with those provisions. -
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIML 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 thisapplication.
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 ownet, 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. 1
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 representatves of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 4/3/2017
Application Number:
8POL2017-0022
Owner:
Property Address:
81905 FOUR SEASONS PL
LA QUINTA HOUS,NG 1 LLC
APN:
767860004
27285 LAS RAM BLAS SUITE 230
Application Description:
MONTERRA / POOL AND SPA AT REAR YARD
MISSION VIEJO, CA 92691
Property Zoning:
Application Valuation:
$14,000.00
Applicant:
Contractor:
J M N SERVICES INC DBA ARCH BLUE
J M N SERVICES INC DBA ARCH BLUE
PO BOX 1215
PO BOX 1215
PALM SPRINGS, CA 92263
PALM SPRINGS, CA 92263
(760)327-1533
---------------------------------------------=-----------------------------------------------
Llc. No.: 879184
Detail: POOL AND SPA AT REAR YARD [JHA ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO
BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
.190
FINANCIAL •R •
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
Credit Card Fee
101-0000-43505
0
$5.39
Total Paid for Credit Cared Fee: $5.39
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 f SPA: $293.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00