BPOL2018-018678-495 CALLE TAMPICO D 4P Qu&M
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: POOL/PRIVATE
Application Number:
BPOL2018-0186
Property Address:
50655 CALLE GUAYMAS
APN:
770094007
Application Description:
LAKES / POOL AND SPA AT REAR YARD
Property Zoning:
Application Valuation:
$40,000.00
Applicant: n 4J
WILLIAM P & JOANNA LAKES f••/
50655 CALLE GUAYMAS OCT 02 20118
LA QUINTA, CA 92253
CITY OF LA QUINTA
DESIGN AND DEVELOOPMFNT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
{commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: License No.:
Date
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any
structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($S00).:
WkAjs owner of the property, or my employees with wages as their sole
co Mpensation, wJII 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
orzhg did not build or improve for the purpose of sale.).
4491as 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:, { 6.4 is _ ==
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 Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/2/2018
Owner:
WILLIAM P & JOANNA LAKES
50655 CALLE GUAYMAS
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No..
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.
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:
Carrie Policy Number:_
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: 10— Z' 12 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):
Application Number:
BPOL2018-0186
Property Address:
50655 CALLE GUAYMAS
APN:
770094007
Application Description:
LAKES / POOL AND SPA AT REAR YARD
Property Zoning:
Application Valuation:
$40,000.00
Applicant:
WILLIAM P & JOANNA LAKES
50655 CALLE GUAYMAS
LA QUINTA, CA 92253
Owner:
WILLIAM P & JOANNA LAKES
50655 CALLE GUAYMAS
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No..
Date: 10/2/2018
Detail: POOL AND SPA AT REAR YARD [DENISE POELTLER ENGINEERING]. NEW EQUIPMENT MUST BE LOCATED IN AN APPROVED LOCATION EITHER
WITHIN THE REAR YARD SETBACK OR 5' MINIMUM FROM THE SIDE P/L--FIELD VERIFY. THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE.
ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$195.05
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$106.11
Total Paid for POOL / SPA: $301.16
DESCRIPTION ACCOUNT CITY AMOUNT
RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION ACCOUNT CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Project Address: vc�L►�a 1 �eJ
APN #:
Applicant Name:
ffAddress::
�2--'
Email: e- A f
V
r Namp
City Bus Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email.
State Lic: City Bus Lic:
r'roperty Owner's Name: Sint
Address:
City, ST; Zip
Telephone:
Email:
PERMIT # RR)LID 16 -Waa
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
TOO( f f 600j Cr L %p a rzi
Valuation of Project $
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction Type:
Grading:
Bedrooms: i Stories:
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal Req'd Ree'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
0
---T• Qa&m
BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 (760) 777-7012
FAX (760) 777-7011
PROPERTY n NERIS PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
1 WPORTANT► NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing_ P P rh'
you with an Owner -Builder May
ildez by having thisui and Information Uerifcation Form to make you aware of your
responsibilities and possible risk you may incur by hang this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
Signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the roe P sion,
Property rty owner, obtain the prior approval of the permitting authority.
DIRECTIQNS Read arrdinitial each s atement below to st�AT)<ON OF ENFORMATION
Sn1`y you understand or verify this infor>,ralion.
I understand a frequent practice of unlicensed persons is to have the property building permit that erroneously implies that the property P P rty owner obtain an `Owner -Builder"
an Owner -Builder, may be held liable and subjec to seriauw r is Providing
risk for orany herinjown labor and ries sustained material Personally.
1, as
and his or her employees while working on my property, My homeowner's insurance may not provide coverage for those
injuries, i e willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workerpersons
W. I understand building Permits are not requited to be signed b
construction and are not o property owners unless they are responsible for the
hi -ring a licensed Contractor to assume this responsibility.
{3. I understand as an "Owner -Builder" I am the re
myself from potential financial risk b responsible party of record an the permit. I understand that I may protect
own. y hiring a licensed Contractor and having the permit filed . his or her name instead of my
I understand Contractors are required by law to be licensed and bonded in California and to list their lice
pemuts and contracts. nee numbers on
L�of my �4. I understand if I employ or otherwise engage any persons, other than California licensed
n er construction is at least five hundred doiIars ($500), including Iabor and materials, 1 may be Considered an "e to
ed Contractors, and the total value
under state and federal law.
nfi yer"
I understand if I am considered an "employer' under state and federal law, I must register
government, withhold payroll taxes, provide workers' co
with the state and federal
compensation for each "employee." I also understand my failure to abide ly drese laws may subject me to serious financial
mpene tioa disability insurance, and subject
me t to unemployment
risk.
understand under California Contractors' State License Law, an Owner -Builder w
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar ear, o builds single-family residential
under contract with a licensed general building Contractor.
y , or all of the work is performed
. I understand as an Owner -Builder if I sell td
result from any latent construction dhe property for which this percent is issued, I may be held for any
nancial or personal injuries sustained by any subsequent owner(s) that effecec ts in the
fi
workmanship or materials.
,gyp �. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
g' W. the United States Small Business Admin►stzatian, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSi B) at 1-
804-321-CSLB (2752) or www.r-slb.ca.gov for more information about licensed contractors.
a. I am aware of and consent to an Owner -Builder building perrnsst applied for in my name, and understand that 1 dd the
1proposed construction activity at the following address:
Pa
legally and fi f ncialiY responsible for .
onsible far this proposed cotastructiatt activity, I will abide by all
agree that, as the party Legally and financially resp In ers.
applicable laws and requirements that govern Owner -Builders as -well as employers
mp y
he
2. I agree to notify the issuer of this form immediately tefda lawsadditdesigned t protect the public. If y, deletions, or changes to any Of tou contract with
have provided on this form Licensed contractors are regulated Y be unable to assist you with any financial loss
someone who does not have a license, theConttractorst. Your State License
againsiounl ceased Contractors may be in civil court. It is also
e working
YOU may sustain as a result of a comp
i ortant for you to understand that if an unlicensed Coif you obtai1 a permit as owner -Builder and wish o hire Clantractors,,
be held liable for damages Y
an your property, You :maylicensed and the stains of their workers
you will be responsible for verifying whether or not those Contractors are properly
compensation insurance coverage.
this form must be completed and signed by the property owner and returned to
Before a building permit can be issued, o the er owner's driver's license, form notarisation, or
the agency responsible for issuing the permit. Note: copy j P ro p ty
other verification acceptable to the agency is required to be presented when fire permit is issued to verify the property
owner's signature. �y r^
Date:��-
signature of property owner
Note: The following Authorization Form is required to be completed by the propertyowner only when designating
an agent of the property owner to apply for a construction permit far the ❑wner Builder.
AUTI'1ORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S bEityLFreby authorize
Excluding the Notice to Property Owner, the execution of which I understand is my p
to apply for, sign, and file the documents necessary to obtain an Owner -Builder
the following person(s) to act as my agent(s)
Permit for my Project -
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Tel No
Address of Authorized Agent:
I declare wider penalty of perjury that I am the property owner for the address fisted above and I personally filled out tine above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the pennir is issued to verify the property owner's signature.
Date:
Property Owner's Signature:
CITY OF LA QUINTA SUB -CONTRACTOR. LIST
JOB ADDRESS _ PERMIT NUMBER OWNER'. __ „BUILD
_This form shall be posted on the job with the Building_ Inspection Card at all times in a cons icuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
i'rade-I Classification
Contractor
State Contractor's License
Workers Compensation :lnsura.nce.
BuM"pss License
Ci;.y -
Company Name
Classification
(e.g. A, B, C-8)
License Number
(Ixxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
P J C' i h
n
C (-(, G so
CONCRETE (C-81
FRAMING (C-5)
STRUC.T. STEEL (C: 51):
ll
MASDNRy (C-29)
PLUMBING IC-36)
kt
LATH, PLASTER (C-35)
DRYWALL (C-9)
-HVAC.(C-20) -
.ELECTRICAL (C-1-01
ROOFING. {C-39) . ..
SHEET METAL::(C-.431.::'.::
-
.FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (.C421
j
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING 7 (C-27)
POOL. (C-53)
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