RPL (11-0369)51705 Avenida Madero
11-0369
P.O. BOX 1504
78-495. CALLE TAMPICO
LA QT PINTA, CALIFORNIA 92253
Application Number:
11-0 00003 69
Property Address:
51705 AVENIDA MADERO
APN:
773-112-004-2 -000000-
Application description:
POOL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
25000
Applicant:
TjV1440"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
CAROL BOGREN
51705 AVENIDA MADERO
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
Date: 4/13/11
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATI
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.. _ I have and will maintain a certificate of consent to self -insure for
License Class: License No.: for by Section 3700 of the Labor Code, for the performance of th
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 (5500).:
(_ 1 1, 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 I, 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.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date 1 wner:
CONSTRUCTION LENDING GENCY
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: L
1 fN
LQPERMIT
work
' compe s provided
e w or. 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
CLCI 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.
. i pplicant:
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 1$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 Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes.
at ), Signat (Applicant or Agent): ]l ti-. \^ /N i-•
wo
-------------------------------
Z
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATI
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.. _ I have and will maintain a certificate of consent to self -insure for
License Class: License No.: for by Section 3700 of the Labor Code, for the performance of th
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 (5500).:
(_ 1 1, 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 I, 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.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date 1 wner:
CONSTRUCTION LENDING GENCY
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: L
1 fN
LQPERMIT
work
' compe s provided
e w or. 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
CLCI 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.
. i pplicant:
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 1$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 Director of Building and Safety 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 county to enter upon the above-mentioned property for inspection purposes.
at ), Signat (Applicant or Agent): ]l ti-. \^ /N i-•
Application Number . . . . . 11-00000369
Permit . .
BLDG POOL PERMIT .
Additional desc .
Permit Fee . . . .
252.00. Plan Check Fee
163.80
Issue Date.
Valuation
25000
Expiration Date
10/10/11
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.0000
----------------------------------
THOU BLDG 2,001-25,000
-----------------------------------------
207.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date
Valuation . . .
. 0
Expiration Date
10/10/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------=-------7-------------------------------------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc
Permit Fee . . . .
45..00 Plan Check Fee
-11.25
Issue Date
Valuation
0
Expiration Date
10/10/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30.0000
---------------------------------------------------------------
EA ELEC PRIVATE SWIMMING POOL
30.00
--------------
Permit . .
PLUMBING
Additional desc .
Permit Fee . . .
33.00 Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date
10/10/11
Qty Unit Charge
Per
Extension
BASE FEE
15:00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
------------------------------------------------------------=---------------
EA PLB GAS PIPE 1-4 OUTLETS
3.00
Permit . . . . . .
WALL/FENCE PERMIT
LQPERMIT
Application Number 11-00000369
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 15.00 Plan Check Fee .00
Issue Date Valuation . . . . 281
Expiration Date 10/10/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
-----------------------------------------------------------------------------
Special Notes and Comments
POOL/SPA, 13 L.F. 5' EQUIPMENT
ENCLOSURE, CITY STANDARD..
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2007 CODES.
---------------------
-----------------------------------------=--------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
------ ----
Credited
------ ---- ----------
Due
------------ - --------------
Permit Fee Total 371.00
.00
.00
371.00
Plan Check Total 189.80
.00
.00 .
189.80
Other Fee Total 1.00
.00
.00
1.00
Grand Total 561.80
.00
.00
561.80
LQPEPMIT
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
1-A QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTA-AT! NO'T'ICE 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 you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having 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 property owner, obtain the prior approval of the permitting authority.
OVVNM'S ACKNOWLEDGMENT AND VERIFICATION OF INFOIEIMAi'ION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice .of unlicensed persons is .to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility_
3. 1 understand as an "Owner -Builder" I am'the responsible party of record on the permit. I understand that I may protect
m self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4. l understand Contractors are required by law to be licensed and bonded in California and to list their license numbers o
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valr
o my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe
under state and federal law.
6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and fede
vernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploym
compensation for each "employee.,, I also understand my failure to abide by these laws may subject me to serious frnanr
risk.
_7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resider
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licer
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfor
under contract with a licensed general building Contractor.
►9' _Y. 1 understand as an Owner -Builder if I sell the property for w-tuch this permit is issued, I may be held liable for any
financial or personal u' y'u les sustained by any subsequent owner(s) that result from any latent conswetion defects in the
workmanship or materials.
9. 1 understand I may obtain more information regarding my obligations as an "employer" from the lnteraal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. 1 also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
_ 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
arty legally and financially responsible for proposed construction activity at the following address:
agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
pplicable laws and requirements that govern Owner -Builders as well as employers.
_ l2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infot tion !
-have provided on this form_ Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you 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.0 nderstand that if an unlicensed Contractor or employee of that individual or film is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors:
You will be responsible for verifying whether or not those Contractors are properiy licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issaing the permit. [Vote; A copy of the property owner's driver's license, forth or
other • verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner ( Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which l understand
is my personal responsibility, I hereby authorize
the following person(s) to act as. my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and -I personally filled out the A
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 permit is issued to verify the property owner's signature.
Property Owner's Signature:. Date: _
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VICINITY MAP
NOT TO SCALE
HATCHED AREA INDICATES
EXISTING TO REMAIN
CONSTRUCTION HOURS
THE CRY OF LA AUIl MUNCPAL CODE SECTION 6.08.050 UNITS
RESDENIVLL AND COMMERCIAL CONSTRUCTION TO THE FOLLOWING HOURS:
OCTOBER 1 - APRIL 30 MAY I - SEPTEMBER 30
Monday-FAUDy 7:000-5:30pm Morxk.YL DOY 6:00-7:00l
Sall 8:0Do,5:00pm SaMdDy 8:00— :00pm
Sudsy NONE SuXlayNONE
Govern. cod. Hold O Gwem. Code HWdoys
NOW NONE
BLOCK WALLS, TRASH ENCLOSURES. TEMPORARY POWER POLES. POOLS. SPAS
REQUIRE SEPARATE PERMITS.
GENERAL INFORMATION
OWNER: Mr. DOUG BOGREN
51705 AVENIDA MADERO
LA QUINTA, CA. 92253
LEGAL DESCRIPTION: A. P. N.: 773-112-004
PROJECT ADDRESS: 51705 AVENIDA MADERO
LA QUINTA, CA. 92253
RECORD BOOK/PAGE: MB 18/55
SUBDIV-NAME LOT: SAMA CARMELITA VALE
LA QUINTA UNIT 2
LOT/PARCEL: 2, BLOCK 26
TOWNSHIP/RANGE: T6SR6E SEC 1
OCCUPANCY: SINGLE FAMILY
TYPE VB NON - RATED
AREA TABULATIONS
Lot Area: 0.16 Acres 6969.6 sq Jt.
E)WIng Residence 2,681 sq.(t.
E7dsting Garage 460 sq.tt.
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TITLE 24 - R..n.mr owl—
P.O. B. 1018. IA "Ll CA 97147
760.485.8927
FAX: 760.777.4714
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' 11bCATION
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LA_
CITY OF
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VICINITY MAP
NOT TO SCALE
HATCHED AREA INDICATES
EXISTING TO REMAIN
CONSTRUCTION HOURS
THE CRY OF LA AUIl MUNCPAL CODE SECTION 6.08.050 UNITS
RESDENIVLL AND COMMERCIAL CONSTRUCTION TO THE FOLLOWING HOURS:
OCTOBER 1 - APRIL 30 MAY I - SEPTEMBER 30
Monday-FAUDy 7:000-5:30pm Morxk.YL DOY 6:00-7:00l
Sall 8:0Do,5:00pm SaMdDy 8:00— :00pm
Sudsy NONE SuXlayNONE
Govern. cod. Hold O Gwem. Code HWdoys
NOW NONE
BLOCK WALLS, TRASH ENCLOSURES. TEMPORARY POWER POLES. POOLS. SPAS
REQUIRE SEPARATE PERMITS.
GENERAL INFORMATION
OWNER: Mr. DOUG BOGREN
51705 AVENIDA MADERO
LA QUINTA, CA. 92253
LEGAL DESCRIPTION: A. P. N.: 773-112-004
PROJECT ADDRESS: 51705 AVENIDA MADERO
LA QUINTA, CA. 92253
RECORD BOOK/PAGE: MB 18/55
SUBDIV-NAME LOT: SAMA CARMELITA VALE
LA QUINTA UNIT 2
LOT/PARCEL: 2, BLOCK 26
TOWNSHIP/RANGE: T6SR6E SEC 1
OCCUPANCY: SINGLE FAMILY
TYPE VB NON - RATED
AREA TABULATIONS
Lot Area: 0.16 Acres 6969.6 sq Jt.
E)WIng Residence 2,681 sq.(t.
E7dsting Garage 460 sq.tt.
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Site Plan
Scale: -114" 11-011
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F.O. Box 1018, IA DUMA CA 92247
760.485.8927
FAX: 760.777.4314
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FILE: 2010 P / 51705 -
DRAWN: S.L.O.
DATE: 01/19/10
SHEET.
3
OF SHEETS.
Submittal 01/19/10
DIU it
Permit #
Project Address: S \'1 0 s A t✓
A. P. Number:
Contractor:
Address:
City, ST, Zip:
Telephone:
State Lic. # : Cit
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
City of La Quinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA. 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
Address:
City, ST, Zip:
Telephone:'1190 -IO ri
..............:...:::::::::::
Project Description: ,. i
Lic. #:
Construction Type: Y
P:
Occupancy:
P
ane
Y:
State
Lic.
Pro
Je
c
t
type (circle rc
le
one): .
New
Add'n Alter Repair Dem
Name of Contact Person: SQA
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:lDO
Total Permit Fees
shmated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Structural Cafes..
Item Amount
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue Electrical
Subconiactor 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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees