BPOL2014-1080LICENSED 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: B, C53, A License No.: 348768
Date: _/,9 — 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.).
(_) 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 Na
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.
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: _ Policy Number: _
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: IO ` I ' I 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 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.
Date: Signature (Applicant or Agent)
f
78-495 CALLE TAMPICO
O�i � D
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011COMMUNITY
DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/1/2014
Application Number:
BPOL2014-1080
Owner:
Property Address:
81385 PEARY
P 4 LA QUINTA
APN:
767680022
78060 CALLE ESTADO
n Z
Application Description:
POOL AND SPA ONLY
LA QUINTA, CA 92253
UJ
Property Zoning:
a
Application Valuation:
$55,000.00
0 o z o
N Z
�.
Applicant:
Contractor:
r_
® g o
w
DURHAM
WESTERN POOLS
4 p
81385 PEARY PLACE
P 0 BOX 5328
U v �'
LA QUINTA, CA 92253
LA QUINTA, CA 92253
e L^7 ,
U
(760)275-2948
r
Llc. No.: 348768
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: B, C53, A License No.: 348768
Date: _/,9 — 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.).
(_) 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 Na
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.
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: _ Policy Number: _
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: IO ` I ' I 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 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.
Date: Signature (Applicant or Agent)
DESCRIP.TION ;- �.• A ; .
FINANCIAL INFORMATION
w LINT, ,
QTY AMOUNT -
:'PAID _
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0 $3.00
$0.00
r. PAID BY
METHOD ;.'`
=RECOPT # c
,..,CHECK#
CLTDBY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $3.00 $0.00
-DESCRIPTION , ., -. -
" ACCOUNT' k
QTY
�AMOUNT
'
� PAID •
PAID DATE
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
PAID BY "•. s
�=. METHOD }:: !'
�` r
' RECEIPT # LL: '
CHECK # f
C LTD BY
DESCRIPTION , t,?{:; +
ACCOUNT ' " a
QTY.
; AMOUNT -
4 'PAID
PAID DATE
SWIMMING POOL/SPA PC '
'101-0000-42600
0
$98.62
$0.00
PAID BY -
> METHOD ,�
`' ;.RECEIPT # ��-
f... ..%CLTD.
."..`CHECK # ,
BY
Total Paid for POOL/ SPA: $279.91. $0.00
iT • 00
®" Permit Details PERMIT NUMBER
City of La Quinta BPOL2014 1080"
Description: POOL AND SPA ONLY
Type: POOL Subtype: Status: SUBMITTED
Applied: 10/1/2014 SKH
Approved:
Parcel No: 767680022 Site Address: 81385 PEARY LA QUINTA,CA 92253
Subdivision: 33076-1 - - - - -- - - Block: -- _Lot:60. _. _ =
Issued:
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $55,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
CITY .` STATE
Details: POOL AND SPA ONLY. [2 INCH GAS PIPING/#8 AWG IN 1 INCH CONDUIT ELECTRICAL] THIS PERMIT DOES NOT INCLUDE BBQ, FIRE PIT
OR EQUIMPMENT WALL. EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER SPECIFICATIONS. ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2013 CALIFORNIA BUILDING CODE.
Printed: Wednesday, October 01, 2014 2:14:43 PM 1 of 2 C ,
SYS iEMS
CONTACTS
NAME TYPE, NAME s°
ADDRESS3
CITY .` STATE
ZIP •: "' R PHONE
;FAX EMAIL ,
t
APPLICANT DURHAM
81385 PEARY PLACE
LA QUINTA CA
92253
CONTRACTOR WESTERN POOLS
-P O BOX 5328
LA QUINTA CA
92253
OWNER P 4 LA QUINTA
78060 CALLE ESTADO
LA QUINTA CA
92253
Printed: Wednesday, October 01, 2014 2:14:43 PM 1 of 2 C ,
SYS iEMS
RIPTION
ACCOUNT
'QTY
AMOUNT
.,PAID
DATE•
RECEIPT#
CHECK #;
_,METHOD
PAID BY
'C LTD
_.
;PAID
BY
SWIMMING POOL/SPA
101-0000-42404
0
$181.29
$0.00
SWIMMING POOL/SPA
101-0000-42600
0
$98.62
$0.00
PC
Total Paid for POOL/ SPA:
$279.91
$0.00
TOTALS:00
INSPECTIONS
SEQID ' INSPECTION TYPE , r INSPECTOR
SCHEDULED' COMPLETED
RESULT' a
REMARKS " NOTES
x
�• . -. _
DATE
DATE=
--'`
FINAL"
ATTACHMENTS
Printed: Wednesday, October 01, 2014 2:14:43 PM 2 of 2 CR
SYSTEMS
Bin #City
Permit #
1
Project Address: 3 S
of La Qulnta
Building &T' Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
/� /cxOwner's Name: 00 r a
A. P. Number:
Address: �e ( 3 gs Fear / tl
Legal Description:
City, ST, Zip: �� ,,pp•��
CXUIK
Contractor: (J
D s
TcicP h nc:
0
Address:
dX J3 2
0.
Projectescption: L —
City, ST, Zip: U !Y(
��
('Ai
IM
Telephone: -7ig �zpQ
State Lic. # : .3qde7 74, g
CityLie. #;
Arch., Engr., Designer.
Address:
:�ity, ST, Zip:
[ ele hone:
P
s..E.:::,.,:::::...:..;_.,:::: ;,::.;•:::.;>.
<
Construction Type: Occupancy:
tato L ic. #:
Pro Ject type circle one): New Add'n Alter Repair r Demo
0
Jame of Contact Person:
e
Sq Ft:
#Stories:
#Units:
�c1cphone # of Contact Person:2 7S Z / a
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES,
Plan Sets
Plan Check submitted
(
Item
Amount
.x
Structural Calcs.
Reviewed; ready for corrections
Plan Cluck Deposit
Truss Cala.
Called Contact Person .
Plan Check Balance.
Title 24 Cala.
Plans picked up
Construction `
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrcctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up"
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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