BPLB2015-0022M
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
DAZ
P 0 BOX 5083
LA QUINTA, CA 92253
f"
Ta4t 4 %'P Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BPLB2015-0022
81542 ULRICH DR
764450038
100 LN FT OF 1" FOR FUTURE FIRE PIT
$1,800.00
FEB 12 2015
CITY OF LA OUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: _ License No.: :LIC -0110584
ate: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that,l,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 Divisio 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
permit subjects the applicant to a civil penalty of not more than five hundred dollar.
($500).:
(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, 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 Addre<
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
a
b
Owner:
AHLSTRAND PATRICIA
81542 ULRICH DR
LA QUINTA, CA 92253
Contractor:
DAZ
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
(760)285-3790
Llc. No.: :LIC -0110584
Date: 2/12/2015
WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penalty of perjury one of the following declarations:
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 fpr -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: lolicy Number: _
I cAfy that in the performance of the work for which this permit is issued, I
shall no loy 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 o he Labor Code, I shall forthwith
compl+FAURE
'sions.
DDI: e::Applicant:
.f4 .
WARNO 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 days1rom 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 ente n the above
mention pro erty for inspection purposes.
,Date v Signature (Applicant or Agent):
EXHIBIT .A
TRILOGY AT LA QUINTA MAINTENANCE ASSOCIATION
DESIGN REVIEW COMMI'T'TEE APPLICATION
(Owner to Complete)
Please complete this request form, the submittal checklist form and attach two (2) copies of your proposed improvement
plans. Incomplete applications will not be considered and will be returned. To assure prompt consideration, review all.
submittal materials for completeness before submitting them to the Design Review Committee through the on-site
Association Management office or by delivery or mail to:
Tilogy at La Quinta Design Review Committee
c/o Action Property Management
60-750 Trilogy Parkway
PA- -F9 iN tom' La,uinta, CA 92253
From: jLA,!-1 (-tC.S i � P'N,rte Date: 12-01 Z$ 0.�
n..
Mailing Address
zL�
Area Code Home Phone Number
Property Address: O t Z> yZ�
Lot No:
City Zip
( `3'3 ) 6..m l `L ��-Cs
Area Code V+ft1 irPhone Number
Tract No:
Architect, Engineer or Owners Representative: (If applicable) Attach additional sheets, if necessary.
Contact
Address. _I — (-N b 3
C
lac_ -e
Company Name
Phone#:
License #:
Type of Work: (Check all that
are appropriate)
❑ I must remove an existing bloc wall in order to complete my project.
F-1AttachedPatio Cover
LFire
Pit, Fireplace
❑ Pot(s) in F/Yard
❑ Solar Panels
❑ Barbecue
❑
Fountain
Rear Yard Landscape
❑. Spa
❑ Drainage System
❑
Front.Gate
❑ Retaining Wall
FI Swimming Pool
❑ Driveway Widening
❑
Front Yard Landscape
❑ Room Addition/Casita
❑ Trellis, Arbor
Ext. Low Voltage Lights
❑Gazebo/Shade
❑ Satellite Dish
❑ Tubular Steel
❑ Ext: High Voltage Lights
❑
Irrigation
EI -Screen - Wall
❑Walt Art @F/Yard
❑ Fence .
❑
Planter
❑ Seat Wall
❑ Wall Art @ R/Yard
❑ Flagpole
❑
Pond
El Sidewalk By Gate'
El waterfall
❑ Other:
Starting Date. LS z:.�s - N��-� �� Za t� Estimated Completion Date` LS, Z c 1 j
THE REVIEW AND/OR APPROVAL OF ANY PLANS, IMPROVEVIENTS, CONCEPTS, CONSTRUCTION, ETC. BY THE DESIGN REVIEW
CONMITTEE AND/OR THE BOARD IS DONE TO CHECK FOR CONFORVIANCE WITH THE CC&RS AND THE DESIGN GUIDELINES AND
DOES NOT WARRANT THE PLANS AS REGARDS TO CONFORiAIANCE WITH ANY APPLICABLE GOVERNING CODES AND ORDINANCES
NOR STRUCTURAL STABILITY OR SUITABILITY.
EXHIBIT `L 2 - PAGE 2
TRILOGY AT LA QUINTA MAINTENANCE ASSOCIATION
DESIGN REVIEW COI�IA1tlITTFM APP LIC" A [TION
(Owner to Complete)
I UNDERSTAND AND AGREE THAT:
1 _
No work on this request shall commence until written approval of ' the Design Review Committee has beer,
received.
2. Any Application shall' be deemed incomplete, and the DRC shall disapprove, any and all plans and/or
specifications submitted to it for approval if the Owner fails to deliver the required fees and security deposit
referenced herein.
3. Owner shall comply with the Design Guidelines for the Trilogy at La Quinta Maintenance Association, and furnish
copies of these provisions to the contractor(s) enraged by Owner for the improvement. Applicant further
understands that it is Owner's responsibility to ensure that his/her contractor(s) also complies with these provisions.
4. The "General Conditions of Approval" section of the Design Standards shall apply to any approval.
5. Owner shall secure proper building permits, if required.by the local governmental entity. Applicant understands
that the City of La Quinta may not approve any plans which have not yet been approved by the
Association's DRC.
6. Owner shall pay the Design Review fees and Security Deposits, identified in Sections 2.5 and 2.6 of the Design
Guidelines to process this Application, the terms of which are incorporated herein by this reference.
7. Applicant agrees to commence work within thirty (30) days of written approval from the DRC and to complete the
work within ninety (90) days thereafter (See Section 1.6 of the Design Guidelines).
8. It is strongly recommended to hold final payment to any contractor doing work on the exterior of the home until
such time that the Design Review Committee ha's inspected the property and the deposit has been refunded. If
any damage has been caused by the contractor to the common area property, the Association will have the
necessary repairs made and deduct the cost from the deposit. Therefore, it is important to wait for the deposit
refund before paying the contractor in full.
9. Applicant shall advise Association office promptly upon completion of the work. Once Applicant submits the
Notice of Completion form, the time frame to ;et a final inspection and a refund- check can vary.
10. Owners shall hold the Association harmless from all liability related to any damage to existing residences,
improvements thereon, any common area property and/or golf course, wherever located with the Trilogy
Community, resulting from the installation/construction of this improvement or modification.
11. Owner(s) agree that he/she/they will be solely responsible for the maintenance of the improvement.
SIGNATURE: if./t'zec_
Owner ate
SIGNATURE:-
Owner
IGNATURE:O mer Date
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INFORMATIONFINANCIAL
DESCRIPTION' s ACCOUNTQTY AMOUNT " -� PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
PAID BY, ` - METHODS RECEIPT # CHECK4# -'; 'CLTD BY'•,
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00,
DESCRIPTION'
ACCOUNT
QTY
AMOUNT ',-
PAID
PAID DATE
PERMIT ISSUANCE '
101-0000-42404
0
$91.85
$0.00
PAID BY R'
n METHOD
-, `"_RECEIPT #
" CHECK #, F,
.. CLTD BY -
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION ., :'1 r " "'
r: ACCOUNT.'
QTY
''� `AMOUNT ''y :y
',PAID`
PAID. DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09 `
$0.00
PAID BY ; .'
"`METHOD `'
'RECEIPT # '
,CHECKV. '
CLTD BY,
DESCRIPTION', +;
ACCOUNT'.-
QTY
AMOUNT .,
PAID—
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$0.00--
�.' . PAID'BY .,
METHOD,
, ` „ ', ""' RECEIPT #
CHECK #
,CLTD BY
Total Paid for PLUMBING FEES: $36.26 $0.00•
TOTALS:00
'
r
Description: 100 LN FT OF 1" FOR FUTURE FIRE PIT
Type: PLUMBING
Subtype: Status: UNDER REVIEW
Applied: 2/12/2015 PJU
Approved:
Parcel No: 764450038 Site Address: 81542 ULRICH DR LA QUINTA,CA 92253
Subdivision: TR 30023-4
Block: Lot: 99
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,800.00
_ Occupancy Type: Construction Type: ..
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
(303)641-9300.
Details: 100 LN FT OF 1" GAS LINE FOR FURURE FIRE PIT 2013 CALIFORNIA PLUMBING CODES.
DAZ
ADDITIONAL SITES
CHRONOLOGY
• DESCRIPTION ,_ ACCOUNT QTY , AMOUNT- PAID ` PAID, DATE _RECEIPT # 'CHECK #.,, METHOD PAID BY
LTD
s
C BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
Printed:.Thursday, February 12, 2015 3:14:38 PM 1 of 2 CRWrsreMs
NAME.TYPE `
,,-
,�,. :NAME., .-
- ' ' ADDRESSI -
CONTACTS
CITY,
a -•
;STATE ZIP .
PHONE- FAX v .. EMAIL --
APPLICANT
DAZ
P O BOX 5083
LA QUINTA
CA 92253
(303)641-9300.
CONTRACTOR'
DAZ
0 OUTSIDE CITY LIMITS
LA QUINTA
CA 92253 '
(303)641-9300
OWNER
AHLSTRAND PATRICIA
81542 ULRICH DR
LA QUINTA
CA 92253
(303)641-9300
• DESCRIPTION ,_ ACCOUNT QTY , AMOUNT- PAID ` PAID, DATE _RECEIPT # 'CHECK #.,, METHOD PAID BY
LTD
s
C BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
Printed:.Thursday, February 12, 2015 3:14:38 PM 1 of 2 CRWrsreMs
SEQID , INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS ; , NOTES
- - 7,—
DATE 4 DATE
PLUMBING FINAL"
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT. DATE+ DUE DATE RETURNED STATUS REMARKS
k NOTES
DATE _
BOND
INFORMATION
0
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE_
RECEIPT #
CHECK #
METHOD
4. PAID BY
'By
BY..PERMIT
-
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$0.00
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$0.00
s
OUTLETS PC
Total Paid for PLUMBING FEES: $36.26 $0.00
TOTALS:0•
SEQID , INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS ; , NOTES
- - 7,—
DATE 4 DATE
PLUMBING FINAL"
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT. DATE+ DUE DATE RETURNED STATUS REMARKS
k NOTES
DATE _
Printed: Thursday, February 12, 2015 3:14:38 PM
2of2
MCRSYSTEMS
BOND
INFORMATION
0
ATTACHMENTS
Printed: Thursday, February 12, 2015 3:14:38 PM
2of2
MCRSYSTEMS
Bin #
Qty of La Q uin to :
-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 #
Project Address: Q G V
Owner's Name:
�
ICA
A. P. Number:
Address:
Legal Description:
City, ST, Zip: Ilk
Contractor:K I'�
Telephone: �Q
d�(�
r<;;>;><s;;:;:««<;`:';>.<>i,>:•.s.;
Address: �x
Project Description:
City, ST, Zip:
�[ C C%
Telephone:00
State Lie. # :
City Lie. #: S
Arch., Engr., Designer:
Address:
City., ST, Zip:
Tele hone:
N:. .; ;;:,.:.•
...................................................
Construction Type: Occupancy:....
State Lie. #
pro ect a circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq.
Ft
t6rre .
#Units:
Telephone #,of Contact Person:
' ated Value of Projoot� S Qo
APPLICANT: DO NOT WRITE BELOW THIS
#
Submittal
Rcq'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
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
2°" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.'
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for corrcctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fces
Total Permit Fees