BPOL2019-005278-495 CALL TAMPICO D Zfu
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: POOL/PRIVATE
Application Number: BPOL2019-0052
Property Address: 53531 AVENIDA CARRANZA
APN: 774115013
Application Description: DERRYBERRY / POOL AND SPA AT FRONT YARD
Property Zoning: a
Application Valuation: $16,500.00
Applicant: V
ANTONIO CECENA MAR 11 2019
52315 CALLE AVILA 0
COACHELLA, CA
ctnof La,autnTA
-DESIGN & 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: 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
s bl cts the applicant to a civil penalty of not more than five hundred dollars ($500).:
N {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.).
j t+_.f 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
Co%ractors' State License Law.).
ALA I am exempt under Sec. B.&P.C. for this reason
Date: Owner: 'La � � i
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/11/2019
Owner:
KEVIN GENE DERRYBERRY
53531 AVENIDA CARRANZA
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:
Carrier-. 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: � i - 1 .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: 1f/- / l tySignature (Applicant or Agent):
Date; 3/1,1/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
ANTONIO CECENA
52315 CALLE AVILA
COACHELLA, CA
BPOL2019-0052
53531 AVENIDA CARRANZA
774115013
DERRYBERRY / POOL AND SPA AT FRONT YARD
$16,500.00
Owner:
KEVIN GENE DERRYBERRY
53531 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
LI c. N'o.:
-----------------------------------------
----- -----------------------------------
Detail: POOL, SPA AT FRONT YARD WITH ELECTRICAL AND GAS LINE [JOHN HENRY HACKER ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT
ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PFE-PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SWIMMING POOL/SPA
101-0000-42404
0
$200.12
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SWIMMING POOL/SPA PC
101-0000-42600
0
$108.87
Total Paid for POOL / SPA: $308.99
-DESCRIPTION
ACCOUNT—
QTY
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: $S.00
TOTALS:
PERMIT # �❑
fJ� . OOS
PLAN LOCATION:
Project Address:�3 �13! ✓� 22an Z� Project Description: Pool, Remodel, Add't, Elect, Plumb,
APN #:
Ntech
Applicant Name:
,04 0% -70-e n .'o
Address: — epol(e
City, ST, Zip:
C% d Gty-r4.o
Telephone:
7,0
Email; _
of Project $
aValuation
Contractor Name:
® y
ir.+N�r
New SFD Construction:
Address:
Conditioned Space
SF
City, St, Zip
Telephone:
Garage
SF
Patio/Porch
Email:
—SF
Fire Sprinklers
SF
State Lic:
City Bus Lic:
Arch/Eng Name:
Address:
a.
Construction Type:
Occupancy:
City, St, Zip
Grading:
Telephone:
Email:
Bedrooms: Stories:
# Units:
State Lic:
City Bus Lic:
Property Owner's Name:
cViN I
Address: 3 _ 5-3/
►9v� c: D
City, ST, Zip
r to eq
Telephone:
Email:
f New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
7 495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
Titf 4 4 Q"
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
7$-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER ourself as the builder of the property
Dear Property Owner:
An application for a building permit has been submitted in your name iisttng y
improvements specified at
We are providing You with an Owner -Builder Acknowledges termit sued nvyv+uename s the � to eke you aware of your
responsibilities and possible risk you may Incur by having p
Owner -Builder. We will not issue x building permit anti! you have read, initialed your understanding of each pruvisrun,
signed, and returned this form to us at our official addrhees indicated.
tiwauthority.
gent of the owner cannot execute this notice
g owner, obtain the prior approval o p
unless you, the property
OWNER' S ACKNO�,EDOMEN'1' c�lvu r �r�r iL•n � x;'• . --- __ .-
J�r�T IQNS: Read and initiaF each statement below to sign yore understand ar verb this rnf°r obtain an "Owner -Builder"
1 i understand a frequent practice of unlicensed persons is to have the hpea labor and material personally. 1, as
big permit that erroneously implies that the property owner is providusg
not provide coverage for those
an Owner -Builder, may be held liable and subject tasriou'Y homeownce er's
by an uniicense person
and his or her employees white working on my property- insurance coverage far injuries to workers
injuries. I am willfiilly acting as an owner -Builder and am aware of the limits of my
on my propem''
understand building p
erxnits are not required to be signed by property own'
unless they are responsible for the
cor0truction and are not }Tiring a licensed Contractor to assume this responsibility. protect
. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
Anellffrom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
puts and contracts.
5. I understand if i employ or otherwise engage any persons, other than California licensed Contractors, and the total value
Y
construction is at least five Hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
f 6. I understand if i amconsidered an "employer" under state and federal law, I must register with the state and federal
g vernment,
withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." i also understand my failure to abide by these laws may subject me to serious financial
risk,
performed by licensed
7. I understand under California Contractors' State � i aeff�'er them aforO sales-Bunlessrall � work builds
s single-family residential
Mures cannot legally build them with the intent calendar year, or all of the work is performed
subcontractors and the number of structures does not exceed four within any Y
under contract with a licensed general building Contractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I rtta r
y.
vial or personal injuries sustained by any subsequent owner(s) that result from any latent cdnsttctionadefectsliable f in the
workmanship or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the Internal e�ice, the United States Small Business Administration, the Cali real Revenue
Division of Industrial Accidents. 1 also understand I may contact the California Contras tractors' Scat Payments,
Board the California
84(1-321-CSLB (2752) or �v,cslb.ca.gov for more information about licensed contractors.
to., I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
egally and financially responsible for p� construction activ'
at the following address:
�] 4/ AfV
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will ab'd
app rcable laws and requirements that govern Owner -guilders as well as employers. y t e by all
—012. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
Yousomeone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
may sustain as a result of a complaint. your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, You may be held liable for damages. If you obtain a permit as Owner-]3ttilder and wish to hire Contractors,
You will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be
the agency responsible for issuing the pc: Note: A cop
other verification arcep able tq thhee u,�e�r }' is aired toy
owner's si nature, J
Signature of property owner
mpleted and signed by the property owner and returned to
II`t re property owner's driver's license, form notarizationor
Presenter) when the permit is issued to ,
verify the property
Dare: -5- 3 - /-F
Note: The following Authorization Form is requiredlte'he completed by theproperty owner only when designatin
an agent ° construction permit for the owner -Builder. g
f theProperty owner to appjy for a
Excluding the Notice to Property Owner, the xe ui ion of whi hT undersiON �anOdPERTy OWNER'S HE
the following person(s) to act as my agent(s) to apply for, sien, and file the documents necessary to obtain an Owner -Builder
is y personal responsibility, I hereby authorize
Permit for my project.
Scope of Construction Project (or Description of Work) 10,0/
Project Location or Address: r11W - -
Name of Authorized Agent:
�� Tel No �7
Address of Authorized Agent:Ap
I declare under penalty of perjury that I the ro e
information and certify its curacy. Not • p
acceptable to the agency is� PY Of
a Hrao.,..f P.
Property Owner's Signature;
e*-
owner for the address listed above and I personally filled out the above
owner's river's license, form notarization, or other verification
n the rmit is issued to verify the property owner's signature.
Date: _ •z'le
pa -zolq - oos-z
CITY OF LA QUINTA
BUILDING DIVISION
REVIEWED FOR
CODE
COMPLIANCE
DATES 1. 2• 01l BY
.�� l.. ptrrt� SQAF
Safety Features - New pools or spas shall be equipped with at
least two of the following drowning prevention safety features.
(H&S §115922 - SB No. 442)
Enclosure that isolates the pool or spa from Dwelling.
Removable mesh fencing, a gate that is self -latching and
closing and can accommodate a key lockable device.
Safety Pool Cover.
Exit alarms on doors that provide direct access to pOO or spa.
A self -closing, self -latching device placed on doors providing
direct access to pool or spa.
An alarm that when places in a pool or spa, will sound upon
• detection. (Surface Motion, Pressure, sonar, Laser)
wmgaiertLL A% Per Section 1705.3 and Table 1705-3 of the 2016 CIBC
Pneumatically Placed Shotcrete squires SP43CIBI Inspection for Construction,
Test Reports will be required from an approved agency detail Ing the fol[owl ng:
Strength tests for shotcrete shall be made by an approved
agency on specimens that are representative of the work and which have been
water soaked for at least 24 hours prior to tesling.
19g8.10.1 $MUWJJ a. Specimens shall be taken from the In -place work of from test
panels. and shall be taken at least once each shift, but not less than one for each
50 cubic yards of shotcrete.
1908.10.2 Panel crlteda. When the maximum -size aggregate is larger Ihan 318
Inch, the lest panels shall have minimum dimensions of 18 In Chas by 18 inches.
When the maximum -size aggregate is 3M in or smaller, the test panels shall have
minimum dimensions of 12 Inches by 12 inches.
"ne cdteria. The average compressive strength of three cubes
taken from the In -place work or a single test panel shall equal or exceed P, with no
individual cube less than 0.88 r,- To check accuracy, locations represented by
erratic core or cube strengths shall be retested,
RECEIVED
MAR 0 5 REED
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
--'_• EXIST ING WOOD PAT O
ails rlNc CONGREr E
rQ SPAY
�N' It, a,
EXISTING
RESIDENCE
EXISTING
ROOM
NEW MAIN HOUSE 200
AMP ELECTRICAL PANEL
i 56 LF 1" ELECTRICAL CONDUIT FOR a GAUGE
WIRING TO POOL EQUIPMENT
INEW 250 GAL
1 PROPANETANK
E 45 LF 2' POLY-ETHELENE GAS LINE _ _
WITH 10 AWG YELLOW TRACER : '
E FTrll�ilili,,
PROPOSED
DRIVEWAY
NEW EQUIPMENT WALL AT 154" _ •F
NEW IRON GATE
0
N\QPGP��PN S M S
Z
3N �
POOLSPECS
POOL SIZE 30' x 15'
POOL SURFACE AREA 398 SQ FT
POOL PERIMETER 101 LIN FT
SPA SPECS
SPA SIZE Tx 7'
SPA SURFACE AREA 49 SQ FT
SPA PERIMETER 28 LIN FT
PLUMBING
POOL PUMP
PENTAIR INTELLIFLO VARIABLE SPEED
PUMP (3HP MAX)
FILTER PENTAIR CLEAN 8 CLEAR
420 SO FT FILTER
HEATER PENTAIR 400-OOOBTU
LOW NOX HEATER
CONTROL SYSTEM
SKIMMER DUAL PORT
LIGHTS „IDDOLPENrAIN LIHT
SPA PEFITAIN LIN
OWNER RESPONSIBILITIES:
. BrEam+t +n nnRa.LE on roocu T+s
nlv.m..Armsl;e In
& UNDERGRO DNSDR D,SNDiwt�N
0 WAGEMCUB%SIDELNS, DRNEWMSWLAWMY
S
.-TH1-11.TNEAREA
WETMOONCRE,E,NELL ATS ONCE DAILY
DRSEVENDAYATEAISIxsiGFD.
ETOA
PDDL EOURPMENT LO—RA SUBJECT,° ACCEPTANCE
aF LpCALBUILDINGDEPARTMENT
POOLMMEDIATELY AFTER PEBBLE OR PLATFA
LfOLLOWINSTRUCTONSI
OMERAPPROVESPLUN POOLANDEOUIPMENT
LOCAHONS AND HAS READ T,E RESPONSIBILMES AND
NOTCES ABOVE
owmul wn _.
RESIDENCE INFO
53531 AVENIDA CARRANZA
LA QUINTA, CA 92253
BUILDER:
vRwEcr seer,
%z7-zols
POOL PLAN
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