BPOL2017-002178-495 CALLE TAMPICO Ct 0 D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPOL2017-0021
Property Address: 81965 FOUR SEASONS PL
APN: 767860001
Application Description: MONTERRA / POOL, SPA AND EQUIPMENT WALL AT REAR YARD
Property Zoning:
Application Valuation: $14,000.00
Applicant:
J 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 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C53 License No.: 879184
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.).
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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/3/2017
Owner:
.LA QUINTA HOUSING 1 LLC
27285 LAS RAMBLaS SUITE 230
MISSION VIEJO, CA 92691
Contractor:
J M N SERVICES INC DBA ARCH BLUE
P 0 BOX 1215
PALM SPRINGS, CA 92263
(760)327-1533
Lic. No.: 879184
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificateof 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' co npensation insurance, as required by
Section 3700 of the Labor Code, for the perfornance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: MIDWEST.EMPLOYERS CASUALTY COMPANY Polity Number:
I certify that in the performance of the work for which this permit is issued, I
I not employ any person in any manner so a s to become subject to the workers'
ipensation laws of California, and agree that, if I should become subject to the
kers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
iply with those provisions.
Date: 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 perform Rd under or pursuant to any permit
issued as a result of this application, the owne and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the =ity 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 applicstion becomes null and void if work is
not commenced within 180 days from date of--ssuance of such permit, or cessation of
work for 180 days will subject permit to cancel'ation. a
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 ordir, antes and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 4/3/2017
Application Number: . BPOL2017-0021
Owner:
Property Address: 81965 FOUR SEASONS PL
LA QUINTA HOUSING 1 LLC
APN: 767860001
27285 LAS RAMBLAS SUITE 230
Application Description: -MONTERRA / POOL, SPA AND EQUIPMENT WALL AT REAR YARD
MISSION VIEJO, Cr192691
Property Zoning:
Application Valuation: $14,000.00
j
Applicant:
Contractor:
J M N SERVICES INC DBA ARCH BLUE
1 M N SERVICES INC DBA ARCH BLUE
P0BOX 1215
PO BOX 1215
PALM SPRINGS, CA 92263
PALM SPRINGS, CA 92263
(760)327-1533
---------------------------------------------------------------------------------------------
Llc. No.: 879184
I
Detail: POOL, SPA, AND 13LF OF 5' H EQUIPMENT WALL AT REAR YARD [JHA ENGINEERING] ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -
PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
r:
FINANCIAL•• •
DESCRIPTION ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600 0
$63.33
Total Paid for BLOCK WALL: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATIOM BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$7.44
Total Paid for Credit Car -J Fee: $7.44
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
:0