13-0567 (RPL)P.O. -BOX .1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000567
Property Address:
•78631 TALKING ROCK TURN
APN:
770-300-029- - -
Application description:
POOL —RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
r
22000
Applicant:
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
4 J
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and effect.
License Class: C53 License No.: 348768
%C Date: s' 5 —/3 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 ($5001.:
(_ 1 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 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 I am exempt under Sec. " , BAP.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 Address:
LQPERMIT
VOICE (760) 777-7012
�T� J FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: "5/02/13
Owner:
BRENGEL,DOUGLAS A & LYNN W TRU
920 AVONDALE RD
SAN MARINO, CA 91108
Contractor:
WESTERN POOLS D Q t
P.O. BOX 5328
LA QUINTA, CA 92248
(760)-200-4777
Lia. No.: 348768 �� 0�!� 213. /
-----------------
--
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.
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 STATE FUND Policy Number 1270996-2013
— 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 became 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 shaU forthwith comply with those provisions. '
;Date:S 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 ($100,0001• 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 tinsgction purposes.
)�ate:S- 3 -i7 . Signature (Applicant or Agent):
LQPERMIT
Application Number .
. . . 13-00000567
Permit . . .
BLDG POOL PERMIT
Additional desc .
Permit Fee
.225.00 Plan -Check Fee
146.25
Issue Date
Valuation
22000
Expiration Date
10/29/13
Qty, Unit Charge.
Per
Extension
BASE FEE
45.00
20.00 9.0000
THOU BLDG 2,001-25,000
180.00
Permit
ELEC POOL PERMIT -RES
Additional desc ,.
Permit -Fee
45.00 Plan Check Fee.
11.25
Issue Date
Valuation-
,0
Expiration Date .".
10/29/13
Qty Unit.Charge
Per
Extension
BASE FEE
15.00
--------1_00 -_-30_0000
EA ELEC. PRIVATE SWIMMING POOL �-_---_-30_00-
I
Permit
PLUMBING
Additional'desc..
Permit Fee . . . .
21.00 Plan Check Fee ._
5.25,
Issue Date
Valuation
0
Expiration Date
10/29/13
Qty Unit Charge
Per
Extension
BASE'FEE
15.00-,
1.00 6.0000
EA' PLB FIXTURE
6.00
---------------
Special Notes and,Comments
REMODEL TO..EXISTING POOL ONLY [DENISE
POELTLER ENGINEERING]
THIS PERMIT DOES
NOT INCLUDE ALTERATIONS TO.EXISTING
EQUIPMENT. ALARMS AND.
BARRIERS REQUIRED
LQPERMIT
Bin. # . .
.01w Of La Quinta
BAUng 8r Safety Division
Permit # P.O. Box 1504,78-495 Calle Tampico
1.a Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 7 (P OC !J! n
Owner's Name:. DU i
A P. Number.
Address:78 & 3 Q ! uTK
Legal Description:
p
Contractor. ee r&rK 1 Dojo
City, ST, Zap: �c
Telephone:
Address: 7E
Project Description:
City, ST, Zip: J hill i o
Telephone: '74,6) 2-D0 11777'
lee llrl e — I I'S l` k 1,.
V
State Lic !i : City Lic. C
Arch-, Eng., Designer.
Address:
City, ST, Zip:
Called Contact Par= Plan Cheek Balance
Telephone:
State Lia g:
Name of Contact Person:
Telephone # of Contact Person:
Construction Type:. Oxupanq:
_ Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:. # Stories:. A Unit;:
1177Z Estimated Value of Project 2— Z zQQO
cool �r•warr. rv, .nT ....,..-r ..
M
Submittal
Plan Set:
Req'd
Recd
TRAClCIIVG PERMr FEES
Pian Check submitted 43 y14447 Item Amount
Structural Cates
~Reviewed, ready for wrrectior s Play Check Deposit.
Truss Cala.
Called Contact Par= Plan Cheek Balance
Title 24 Calci.Plans
picked up Construction
Flood ptalu plan
Plans resubmitted Mechanical
Grading plan
Z`` Review, ready for correctiow/asue Electrical
Subcostactor List
Called Contact Person Ptumbiag
Grant Deed
Plans plcked up S.M,L
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
Review; ready for correctionslissue Developer Impact Fee
Planning Appal
Called Contact Person P.
Pub. Wks. Appr
Date of permit Issue
School Fees
I Total F t F IN 1A
SI 2. lon - a5ooY -0 %4t^ye-
WaA4��fs 'Co PiA.�O'r �.
pUlt_L,11�91a t5k JHl`t I Y Utl' I.
APPROVED
FOR CONSTRUC ION
DATE g
1 i
i
S
Re A"o ve Pool
4.
1 i
i
S
Re A"o ve Pool