BPOL2019-005678-495 CALLE TAMPICO C% D 4
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: POOL/PRIVATE
Application Number: BPOL2019-0056
Property Address: 52525 AVENIDA BERMUDAS
APN: 773305013
Application Description: DORSEY / POOL AND SPA AT FRONT COURT YARD
Property Zoning:
Application Valuation: $30,000.00 D
Applicant:
TESERRA
P 0 BOX 1280 MAR 19 2019
COACHELLA, CA 92236
CITYOF LAQUINTA 0
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 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Clas : C.S.r7q. rc;-4_ C27 012 1 i nse No.: 656128
L aw, Va __'_ <----
ContraAr: [
OWNER -BUILDER DECLARA
I hereby affirm under penalty of perjury that I am a pt 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 N
Lender's Addres
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/19/2019
Owner:
WENDELL E DORSEY & TIFFANY DORSEY
52525 AVENIDA BERMUDAS
LA QUINTA, CA 92253
Contractor:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
(760)389-9222
Llc. No.: 656128
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 war for which this permit is issued.
_ have and will maintain workers' compensation insurance, as required by
lEction 7 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5014959
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 hose pr isions.
Oat App11
WARNING: FAIL RE TO SECURE WORKERS' COMPENSATI COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). I DDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN ECTION 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-menti ned p perty for inspection purposes.
Date, 4 SigrivWk (Applicant orAg t
Date: '3%19/201b
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
TESERRA
P O BOX 1280
COACHELLA, CA 92236
BPOL2019-0056
52525 AVENIDA BERMUDAS
773305013
DORSEY / POOL AND SPA AT FRONT COURT YARD
$30,000.00
Owner:
WENDELL E DORSEY & TIFFANY DORSEY
52525 AVENIDA BERMUDAS
LA QUINTA, CA 92253
Contractor:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
(760)389-9222
Llc. No.: 656128
Detail: POOL AND SPA AT FRONT COURT YARD [DOUGLAS R. FERRELL 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. SPECIAL INSPECTION REPORT REQUIRED AT PRE PLASTER. 2016
CALIFORNIA BUILDING CODE
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
+ DESCRIPTION I ACCOUNT I CITY I AMOUNT
TECHNOLOGY ENHANCEMENT FEE 1502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
ta
-- GENI y rA DHS1:R"f -
PERMIT # �j1'�Ll "' 001�6
PLAN LOCATION:
Project Address:
�R
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
�J `i "
Applicant Name:
�' I�Aorye
Address:
City, ST, Zip:
Telephone: C)-2
7 ,�r— Ll
Email: eU ILL
/
Valuation of Projects �� � � � , �r�C2
Contractor Name:
New SFD Construction:
Address: 0 [- - 10 S� ��
Conditioned Space SF
City, St, ZipC0 1 I
/
Garage SF
Patio/Porch SF
Telephone:
� r
Email:
Fire Sprinklers SF
State Lic: 6 ,5' / City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories: # Units:
Email:
State Lie: City Bus Lic:
Property Owner's Name: r
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000