BPLB2017-012378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BPL82017-0123
Property Address:
78631 TALKING ROCK TURN
APN:
770300029
Application Description:
BRENGEL / 1/2 GAS LINE TO BBQ FROM EISITNG
Property Zoning:
Application Valuation:
$500.00
VOICE (760) 777-7125
FAX. (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DOUGLAS BRENGEL"
345 E COLORADO BLV NO 203
PASADENA, CA 92253
Date: 9/11/2017
Applicant: D �u I Contractor:
ENGSTROM CONSTRUCTION MANAGEMENT -----jl ENGSTROM CONSTRUCTION MANAGEMENT
77455 EVENING STAR.CIRCLE 77455 EVENING STAR CIRCLE
INDIAN WELLS, CA 92210 SEP 1 1 2017 INDIAN WELLS, CA 92210
CITY OF LA 06kA (760)668-3961
COMMUNITY DEVELOPMENT DEPARTMENT LIC. No.: 835648
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 CI ss: B License No.: 835648 _
Date: Contractors ,r4v
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
Dater 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
Lender's Address:
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'
co en on, as provided for by Section 3700 of the Labor Code, for the performance
of w k r which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
S ctio 700 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 COMPENSATION INSURANCE FUND Policy Number: 9022651
_ 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 t at, if I should become subW ct to the
workers' compensation provisions of Sect' 370 of the Labor C e, all forthwith
co�mpl rw' h tho a provisions.
Date" At police it.
WARNING: FAILURE TO SECURE WOR RS' 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 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 officer's, 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 th' ci y to enter up n t above -
menti a prop ty for inspection purposes.
Oast Signature (Applic'anfor. .
r
Date: 9/11/2017
Application Number: BPLB2017-0123 Owner:
Property Address: 78631 TALKING ROCK TURN DOUGLAS BRENGEL
APN: 770300029 - 345 E COLORADO BLV NO 203
Application Description: BRENGEL / 1/2 GAS LINE TO BBQ FROM EISITNG PASADENA, CA 92253
Property Zoning:
Application Valuation: $500.00
Applicant: Contractor:
ENGSTROM CONSTRUCTION MANAGEMENT ENGSTROM CONSTRUCTION MANAGEMENT
77455 EVENING STAR CIRCLE 77455 EVENING STAR CIRCLE
INDIAN WELLS, CA 92210 INDIAN WELLS,.CA 92210
(760)668-3961
Llc. No.: 835648
Detail: 1/2 INCH GAS LINE FROM PRE EXISITNG BBQTO NEW BBQ PER 2016 CALIFORNIA PLUMBING CODE.
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FINANCIALIN FORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00'
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
'QTY
AMOUNT,
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
' Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
•$140.27
Bin#
City of La Quinta:
Building & Safety Division
78-495 Calle Tampico
La •Quinta, CA 92253— (760) 777-7012 `
t0la, uilding Permit Application and Tracking Sheet
Permit#
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Project-Addres
O_wnerfs-Name: jQ ��
A.P. Number ?
Address:.' if(2
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Legal Description:
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Contractor:
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Telephone:
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'Project De'scription:-�
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City Lie #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type:
Occupancy:
Proj. Type
New
Add'n
Alter
.Repair
Demo
Name of Contact
SgFt:
#Stories
# Units:
Telephone of Contact:
Est* m " d- slue-of-Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cales
Reviewed, ready for corrections
Plan Check Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechanical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees
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REMODELED
AREA
Wall w/Planting
BBQ Section
SCALE: V