BWFE2017-016978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BWFE2017-0169
Property Address: 78631 TALKING ROCK -TURN
APN: 770300029
Application Description: BRANGEL/ 9 LF IN REAR PROPERTY FOR BBQ
Property Zoning:
Application Valuation: $1,000.00
Applicant: D
ENGSTROM CONSTRUCTION MANAGEMENT
77455 EVENING STAR CIRCLE I
INDIAN WELLS, CA 92210
SEP 1 1 2017
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
.Date: 9/11/2017
Owner:
DOUGLAS BRENGEL
345 E COLORADO BLV NO 203
PASADENA, CA 92253
Contractor:
ENGSTROM CONSTRUCTION MANAGEMENT
77455 EVENING STAR CIRCLE
INDIAN WELLS, CA 92210
CITY OF Ila OUINTA (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 Cl a : B License No.: 835648
Date: Contractor: VAJ vJ ,
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.).
(_)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 Name
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'
ation, as provided for by Section 3700 of the Labor Code, for the performance
of t k for which this permit is issued.
f A have and will maintain workers' compensation insurance, as required by
S 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
_ 1 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 3 00 the Labor C de, , forthwith
complUhthose provisions.D?�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 ($100,000)..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 la s relating to building
construction, and hereby authorize representatives of this ci t nter up t ove-
menn d pr erty for inspection purposes.
Date J Sigoature.(Applicanto_ a or gen'
Date: 9/11/2017
' Application Number: BWFE2017-0169
Owner:
Property Address: 78631 TALKING ROCK TURN
DOUGLAS BRENGEL
APN:: 770300029
345 ECOLORADO BLV N0.203
Application Description: ' BRANGEL / 9 LF IN REAR PROPERTY FOR BBQ
PASADENA, CA 92253
Property Zoning:
Application Valuation: $1,000.00 .
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
Lic. No.: 835648
------------------------------------------------- ------------- --------------------,------.----
Detail: 9LF GARDEN WALL AT REAR YARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED
COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE AREA BETWEEN THE BACK OF CURB AND ANY FENCING SHALL BE-LANDSCAPED, HAVE A
SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER: 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION
a a • aON
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404 0
$50.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
.101-0000-42600 0
$63.33
Total Paid for BLOCK WALL:
$114.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
BSAS SR1473 FEE
101-0000-20306
0.
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
•$5.00
Bin#
City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Permit#
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Project_Address'
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Qwnerrs Name:
_
A.P. Number
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Address:..'
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Legal Description:
City, ST dip: ;
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Pr�oject'Descripfion:
City",.ST;Zip•
Telephone. /�
State-Lic:'-#� r
City Lic #:
Arch, Engr., Designer:
Address- .
City, ST, Zip:
Telephone:
Construction Type:
Occupancy:
State Lic. #:
Proj. Type
New
Add'n
Alter
Repair
Demo
Name of Contact-,
SgFt:
# tories
# Units:
Telephone of Contac t1' A
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10
Esti' e VaIOuOject
APPLICANT: DO NOT WRITE IIELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
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
Picked Up
S.M.I.
HOA Approval
Resubmitted
L3rd
Grading
IN-HOUSE
ev, 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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