BRES2014-108978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number:
BRES2014-1089
Owner:
Property Address:
81130 SHINNECOCK HILLS
DOUGLASS EMBERTON
APN:
762340005
81130 SHINNECOCK HILLS
Application Description:
81SF ROOM ADDITION
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$10,000.00
t
z_ I
0
Applicant:
Contractor: o
LARRY LANG CONSTRUCTION LLC.
LARRY LANG CONSTRU Q
80-590 CAMINO FAN GREGORIO
80-590 CAMINO FAN G
INDIO, CA 92203
INDIO, CA 92203 m
v
Llc. No.:
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: �6�'��—'' 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.).
(_) 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.).
(_) 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 Name
Lender's
Date: 10/8/2014
O
n
0
LL6o
;IOo
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 tWi.n3
or which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
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:-1110-198—If Applicant:L- Owe-(k'T,V/�
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 t ove-
mentioned property for inspection purposes.
Date: %- Signature (Applicant or Agent): ''j'
DESCRIPTION ..
FINANCIAL INFORMATION
ACCOUNT ',
QTY AMOUNT;
PAID
PAID DATE..
ADDITION, FIRST 100 SF
101-0000-42400
0 $120.12
$0.00
PAID BY
-METHOD
" RECEIPT #- .
CHECK #
CLTD BY,.
DESCRIPTION
ACCOUNT. ;:
QTY
AMOUNT.:'
PAID ;
PAID DATE:
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$168.74
$0.00
PAID BY
'METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forADDITION: $288.86 $0.00
DESCRIPTION
ACCOUNT,',
QTY
AMOUNT,
PAID' :.
PAID DATE..
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY"
..,METHOD
RECEIPT #. ` .`
CHECK '#
CLTD BY.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID.::
PAID DATE
HOURLY PLAN CHECK - YES
101-0000-42600
1
$70.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION :'
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HOURLY PLAN CHECK - YES
101-0000-42600
1
$70.00
$0.00
PAID BY
METHOD
RECEIPT #.
CHECK #:;
CLTD BY
DESCRIPTION
ACCOUNT •
QTY
AMOUNT
PAID
PAID DATE
HOURLY PLAN CHECK - YES
101-0000-42600
1.25
$87.50
$0.00
PAID BY
METHOD
RECEIPT #
CHECK # :,
CLTD BY
Total Paid forCITY STAFF - PER HOUR $227.50 $0.00
DESCRIPTION:
ACCOUNT ;.
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403.
0
$23.83
$0.00
PAID BY
METHOD:
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
'PAID"
PAID,DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
PAID BY
METHOD
•RECEIPT # -
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $47.66 $0.00
DESCRIPTION , .
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$1.30
$0.00
PAID BY
METHOD
RECEIPT #
CHECK
CLTD.BY
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.30 $0.00
• 00
0
t
B
0
Description: 81SF ROOM ADDITION
A.001TONAL
CHRONOLOGY
STAFF NAME ACTION DATE COMPLETION DATE NOTES
NOTE
Type: BUILDING, RESIDENTIAL
Subtype: ADDITION Status: APPROVED
Applied: 8/13/2014 AOR
Approved: 10/8/2014 JJO
Parcel No: 762340005 Site Address: 81130 SHINNECOCK HILLS LA QUINTA,CA 92253
Subdivision: TR 29147-1
Block: Lot: 13
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $10,000.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
KAY HENSEL
Details: PLANS APPROVED 10/8/2014 .SMALL ADDITION ENCLOSING OPEN AREA NEAR LIVING AREA & ENTRY ONLY.81 SQ. FT.
CHRONOLOGY TYPE
A.001TONAL
CHRONOLOGY
STAFF NAME ACTION DATE COMPLETION DATE NOTES
NOTE
JIM JOHNSON
10/8/2014
10/8/2014
VARIFY CONTRACTORS CITY AND STATE LIC.
PLAN CHECK COMMENTS
FROM CONSULTANT
RECEIVED
KAY HENSEL
10/8/2014
10/8/2014
APPROVED W. CONDITIONS 10/7/14
PLAN CHECK PICKED UP
KAY HENSEL
9/15/2014
9/15/2014
RESUBMITTAL
KAY HENSEL
9/19/2014
9/19/2014
DUE BACK 10/2/14
SENT TO PLAN CHECK
CONSULTANT
KAY HENSEL
9/19/2014
9/19/2014
TELEPHONE CALL
JIM JOHNSON
10/8/2014
10/8/2014
CALLED APPLICANT TO PICKUP PLANS APPROVED.
CONDITIONS
Printed: Wednesday, October 08, 2014 2:19:45 PM 1 of 3
Printed: Wednesday, October 08, 2014 2:19:45 PM 2 of 3
CONTACTS
DESCRIPTION
r..
NAME TYPE
NAME
ADURESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
LARRY LANG CONSTRUCTION LLC,
80-590 CAMINO FAN
INDIO
CA
92203
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.12
$0.00
GREGORIO
ADDITION, FIRST 100 SF
101-0000-42600
CONTRACTOR
LARRY LANG CONSTRUCTION I.I.C.
80-590 CAMINO FAN
INDIO
CA
92203
PC
GREGORIO
OWNER
DOUGLASS EMBERTON
81130 SHINNECOCK
LA QUINTA
CA
92253
HILLS
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HOURLY PLAN CHECK -
101-0000-42600
1
$70.00
Printed: Wednesday, October 08, 2014 2:19:45 PM 2 of 3
FlIlly IV, FINANCIAL INFORMATION
DESCRIPTION
r..
ACCOUNTS-,
CITY..
AMOUNT PAID PAID DATE
RECEIPT# CHECK#
METHOD:';
;: PAID'BY c
CLTD ,
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.12
$0.00
ADDITION, FIRST 100 SF
101-0000-42600
0
$168.74
$0.00
PC
Total Paid forADDITION: $288.86 $0.00
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HOURLY PLAN CHECK -
101-0000-42600
1
$70.00
$0.00
YES
HOURLY PLAN CHECK -
101-0000-42600
1
$70.00
$0.00
YES
HOURLY PLAN CHECK -
101-0000-42600
1.25
$87.50
$0.00
YES
Total Paid forCITY STAFF - PER HOUR: $227.50 $0.00
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
-
Total Paid for ELECTRICAL: $47.66 $0.00
Printed: Wednesday, October 08, 2014 2:19:45 PM 2 of 3
DESCRIPTION ACCOUNT QTY: AMOUNT.. PAID, PAID DATE RECEIPT # CHECK # . METHOD PAID BY
CLTD
)BY
SMI - RESIDENTIAL 101-0000-20308 0 $1.30 $0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.30 $0.00
Printed: Wednesday, October 08, 2014 2:19:45 PM 3 of 3
RETURNED
STATUS
REMARKS
REVIEW TYPE
REVIEWER
SENT DATE
DUE DATE
NOTES
DATE
TOM
CORRECTIONS
Applicant called
NON-STRUCTURAL
8/13/2014
8/27/2014
9/12/2014
REVISIONS REQUIRED
1 week resubmittal list. Easy turn around
HARTUNG
REQUIRED
STRUCTURAL
TOM
8/20/2014
8/27/2014
9/26/2014
REVISIONS REQUIRED
CORRECTION S
STRUCTURAL FROM YOUNG READY FOR
HARTUNG
REQUIRED
CORRECTIONS.
NON-STRUCTURAL
JIM JOHNSON
9/26/2014
9/26/2014
9/26/2014
APPROVED
NON STRUC
NON STRUC APPROVED
APPROVED
BUILDING
9/26/2014
10/10/2014
10/8/2014
APPROVED
APPROVED
STRUCTURAL,
APPROVED
BUCKET
Printed: Wednesday, October 08, 2014 2:19:45 PM 3 of 3
in #
I -C
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
flab - WQa
Pro ct Address: !n , I s
Owner's Name: 1DOU 4, C
A. P. Number: —7 40 Qpm
Address: 8 _ 3� � �,,�,� �•� t S
Legal Description:
City, ST, Zip: LA 0 V P4 TAq--,7,2 S—
c..
Contractor: �,�. L a.js%iZlJ�i-�-,v�1%
Telephone: 7(oo,'7?7, I a
Address:
Project Description:I igmAu,
City, ST, Zip: ZNIbw, Cit �V�✓lV
GLl%� l Nr�-
en
Tlehoe
P
L yr
State Lic. # : rj
City Lic. M.
Arch., Engr., Designer:
Q ,
Address: SD 5 fQ (fAM NID
City., ST, Zip:
Telephone:ne:
Con •_
stracttn Type: V 5 Occupancy:
State Lic. %
Project type (circle one):: Ne Alter Repair Demo
Sq. Ft.: # Stories: I # Units:
Name of Contact Person: 6.At�
Telephone # of Contact Person: %0, QZd'
Estimated Value of Project: (a? O490
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
$� 13114
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Z
Plan Check Deposit
Truss Calcs.
Called Contact Person 7"
Plan Check Balance.
Title 24 Calcs.
Plans picked up
q l �J
Construction
Flood plain play
Plans resubmitted
9
Mechanical
Grading plan
god Review, ready for correction /issue
0
Electrical
Subcontactor List
Called Contact Person
!Q
Plumbing
Grant Deed
Plans picked up
S.M.I.
R.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' 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
sjav - �/3 9/�,e-�c� : �fz�G�� N6*au%1WU4 A -pp.
MIS AF4 7`�/y � CITY OF LA'QUINTA
COMMUNITY DEVELOPMENT
Coachiella valley Unified School District
83-733 Avenue 55, Thermal, .CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVF.T.OPFR FFFR PATII
AREA: -
AMOUNT -
LEVELONEAMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMWIND. AMOUNT:
DATE:
RECEIPT:
CHECK#:
INITIALS .
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Embe o Date: September 18, 2014
Owner's Name: Phone No. (805).794-2688
Project Address: 81-130 Shinnacock Hills, La Quinta, CA 92253
Project Description: Room Addition
APN: 762-340-055 Tract #: Lot #'s:
Type of Development: Residential XX, Commercial Industrial
Total Square Feet of Building Area: 81 Sq. Ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of t e o veloper.
Dated: D Signature: '
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87Requirement
Number of Sq.Ft. 81 Sq. Ft.
Amount per Sq.Ft. EXEMPT
Amount Collected 0.00
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Certificate issued by: Leticia Torres, Facilities Analyst Sign lure:
- — - --- - -- .. , �." "'"r"vNE`IV41< yr Ir EEE
Section 66020 of the Government 'Code asserted by Assembly Bill 3081, effective January 1, 1997, requires t a this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions"Fees"
( ), of the 90 -day period to protest the Fa
o ' 'on of these
Fees and (2) the amount of the'fees. Therefore, in accordance with section 66020 of the Government code and f aw Is sha serve to
advise you that the 90 -day protest period in regard to such Fees or. the validity thereof, commences with the pay t e fees or �e cny other
is
requirementsas'desciibed in section 66020 of the Government code. Additionally, the amount of the fees imposeddel t h, whet.payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for,thirty. (30) days from the date.of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. r.
M V:c/mydocs/devfees/certificate of compliance form updated 3-2007 SCP 18 2014
11/2010
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
.
COMMUNITY DEVELOPMENT DEPARTMENT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'
(760) 777-7012 FAX (760) 777-7011
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB: 81-130 SHINNACOCK HILLS
APN: 762-340-055
DESCRIPTION OF WORK: ADDITION
SQUARE FOOTAGE: 81 SQ: FT.
OWNER'S NAME: EMBERTON
For questions regarding this letter, please call:
City of La Quinta Permit Center
(760) 777-7012
Coachella Valley Unified School District
83-733 Avenue 55
P0Box 847
Thermal, CA 92274
(760).398-5909
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta CA 92253
(760) 771-8515
i
CITY OF LA QUINTA
BUILDING & SAF
APp ETY DEPT,
FOR COS ED
CTION
►T� 4112%la a
Please note: This letter verifies conditioned square foot Me
your School District to verify school fees, requirement ti
or money order and hours of operation.
SEP 1 8 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
77-682 Country Club Dr. Ste. 13, Palm Desert, CA 92211 ph. (760) 77275107 fax (760) 345-7620
Letter of Transmittal
To: City of La Quinta Today's Date: 10-7-14
78-495 Calle Tampico City Due Date: 10-2-14
La Quinta, CA 92253. Project Address: 81-130 Shinnecock Hills
Attn: Angelica Plan Check #: BRES 2014-1089
Submittal: ❑ 1st ❑ 4th
® 2nd ❑ , 5th
❑ 3'd ❑ Other:
We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup
Includes: # Of Descriptions: Includes: # Of Descriptions:
Copies: Copies:
❑ Structural Plans ® 1 Revised Structural Plans
❑ Structural Calculations ® 1 Revised Struct. Calcs
❑ Truss Calculations Floor ❑ Revised Truss
and Roof
❑ Soils Report . ❑ Revised Soils Report
® 2 Structural Comment List/ ❑ Approved Structural Plans
Responses
® 1 Redlined Structural Plans ❑ Approved Structural Calcs
® 1 Redlined Structural Calcs ❑ Approved Truss Calcs
❑ ,e " Redlined Truss Calcs ❑ Approved Soils Report
❑ Redlined Soils Reports ❑ Other:
Comments: Structural content is approvable, pending the Engineer -of -Record specifies special inspection
for concrete strength over 2500 psi and epoxied. dowels on structural plans.
If you have any questions, please call.
Time= 1.25 HR nzQ
This Material Sent for:
❑ Your Files ® Per Your Request
❑ Your Review ❑ Approval
❑ Checking ❑ At the request of:
Other: ❑
By: Kathryn Samuels
Palm Desert Office: ® (760) 772-5107
Other: ❑
RECEIVED
4£T U 7 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
ML
PGA WEST.
FAIRWAYS ASSOCIATION
July 22, 2014
Douglass Emberton
81-130 Shinbec6ckHills
La Quinta, CA 92253
Re: Architectural Application — 81130 Shinnecock Hdls
Dear. -Homeowner.
The Architectural ' Committee has reviewed your 'request to modify the front of your residence. I am
pleased to inform you that the Architectural Committee has approved the application after the site visit
was performed.
ff you have any questions, please contact Cassie Gertz - at 760-776-5100 Ext 6345 or email
Cassie.Gelg@Managementtrust.com_
Sincerely,
For the Architectural Contmiftee
.CGA -WEST Fairways Association
File
CCAM, PCAM
Committee
RECEIVED,
F SEP 1 2014
E17y OF LA QUINTA
COMMUNITY DEVELOPMENT
Post Office Box 1690 - La Quinta, California 92247 - Phone (760) 776-5100 - Fax (760) 776-5111 - www.pgawestfairways.com