BPLB2016-005278-495 CALLE TAMPICO D �NNI�Cl/
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
i 111111 11111 1111 1111
2,
VOICE (760) 777-7125
FAX (760)777-7011
INSPECTIONS (760) 777-7153
Application Number:
BPLB2016-0052
Owner:
Property Address:
80500 CHAMPIONS WY
RREF II CWC LAQ LLC•
APN:
775220021
5927 PRIESTLY DR STE 110
Application Description:
GALLOGLY /GAS LINE FIRE PLACE
CARLSBAD, CA 92008
Property Zoning:
Application Valuation:
$600.00
Applicant: Contractor:
TESERRA TESERRA
P 0 BOX 1280 P 0 BOX 1280
COACHELLA, CA 92236 COACHELLA, CA 92236
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: C-8. C10—C29. C53. C27, D12 License No.: 656128
Date: 1� `1 .L �� (,--Contractor: _f
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).:
(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 I 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
Lender's Address:
(760)389-9222
Llc. No.: 656128
Date: 3/23/2016
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
ofwot/k for which this permit is issued.
r71 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: _ 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: 37 oC , I (J 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 laws relating to building
construction, and hereby authorize representatives of this city to enter u A the
above-mentioned property for inspection purposes.
Date: 3:�27-f 6 Signature (Applicant or
DESCRIPTION
FINANCIAL INFORMATION
- ACCOUNT
QTY AMOUNT
PAID PAID DATE:
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$1.00 3/23/16
PAID BY
METHOD
--RECEIPT #
CHECK #. CLTD BY
TESERRA
CHECK
R14113
134120 RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00. $1.00
DESCRIPTION '
ACCOUNT
QTY
,:AMOUNT `:
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85'
3/23/16
PAID BYMETHODT1.
RECEIPT.V:
CHECK #. ;.
CLTD BY.
TESERRA
CHECK
R14113
134120
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
DESCRIPTION.
ACCOUNT
QTY
AMOUNT .
PAID .j
PAID DATE
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.09
$12.09
3/23/16
PAID By.:
METHOD
RECEIPT ,#:;;
CHECK #
CLTD BY
TESERRA
CHECK
R14113
134120
RSE
DESCRIPTION .
ACCOUNT ;.
QTY
`: AMOUNT.
:PAID
PAID DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$24.17
$24.17
3/23/16
PAID BY
METHOD ..
RECEIPT #
CHECK # .:.
CLTD: BY
TESERRA
CHECK
R14113
134120
RSE
Total Paid for PLUMBING FEES: $36.26 $36.26
Description: GALLOGLY / GAS LINE FIRE PLACE
NAME TYPE
NAME
Type: PLUMBING
Subtype:
Status: UNDER REVIEW
Applied: 3/23/2016 RSE
Approved: .
Parcel No: 775220021 Site Address: 80500 CHAMPIONS WY LA QUINTA,CA 92253
Subdivision:
Block:
Lot:78
Issued:
Lot Sci Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $600.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
RREF II CWC LAQ LLC
Details:
CARLSBAD
CA
92008
CHRONOLOGY
NAME TYPE
NAME
ADDRESS1
CONTACTS
CITY
STATE
ZIP PHONE FAX
EMAIL
APPLICANT
TESERRA
P 0 BOX 1280
COACHELLA
CA
92236
CONTRACTOR
TESERRA
P 0 BOX 1280
COACHELLA
CA
92236
OWNER
RREF II CWC LAQ LLC
5927 PRIESTLY DR STE
110
CARLSBAD
CA
92008
Printed: Wednesday, March 23, 2016 10:03:06 AM 1 of 2
SYSTEAAS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
3/23/16
R14113.
134120
CHECK
TESERRA
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
GAS SYSTEM, 1-4
101-0000-42401
0
$12.09
$12.09
3/23/16
R14113
134120
CHECK
TESERRA
RSE
OUTLETS
GAS SYSTEM, 1-4
101-0000-42600
0
$24.17
$24.17
3/23/16
R14113
134120
CHECK
TESERRA
RSE
OUTLETS PC
Total Paid for PLUMBING FEES: $36.26 $36.26
TOTALS: $129.11 $129.11
BOND INFORMATION
Printed: Wednesday, March 23, 2016 10:03:06 AM 2 of 2
0TSYS7Eti1S
_ w _
APPLICANT: DO NOT WRITE BELOW THIS LANE
#
Submittal Req'd
Plan Sets
City ®f nta
Structural Ca1cs.
.La
Plan Check Deposit
Building U Safety Division
Permit #
Called Contact Person
P.O.. Box 1504, 78-495 Calle Tampico
La Quinta, Cel 92253 - (760) 777-7012
Plans picked u
Building Permit Application and Tracking Sleet
Project Address:
Owner's Name: , 0
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: L�J`�C
Telephone:
Address: 9(>-120 V6
Project Description:
City, ST, Zip: (O -
`1"77-7-3(�
Telephone:
Plumbing
State Lic. # :
City Lic. #: Li 7r. c -T
Arch., Engr., Designer:
i
Address:
City, ST, Zip:
Plans resubmitted
Telephone:
Construction Type: Occupancy:
9
State Lic. #:'
_ Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:5reowa,A
Sq. FL: # Stories: # Units:
Telephone # of Contact Person:
70 Q 1�7! Estimated Value of Project:/7/7C---
APPLICANT: DO NOT WRITE BELOW THIS LANE
#
Submittal Req'd
Plan Sets
Recd TRACMG . PFRMIT FEES
Plan Check submitted Item e Amount
Structural Ca1cs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
anergy Calcs..
Plans picked u
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
2a° Review,'ready for correctionsTWue `.Electrical
Subcontactor List
Called Contact Pelson
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval.
Plans resubmitted
Grading
IN HOUSIE:-
'"' 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