BPOL2019-000878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
POOL/PRIVATE
BPOL2019-0008
80500 CHAMPIONS WY
775220021
c&t!t 4 4 Q"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
GALLOGLY / POOL, AND BARBEQUE AT REAR YARD
$31,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GALLOGLY FAMILY TRUST
80500 CHAMPIONS WAY
LA QUINTA, CA 92253
DPContractor:
TESERRA
JAN 16 2019 P 0 BOX 1280
COACHELLA, CA 92236
CITY OF LAOIfINTA (760)389-9222
DESIGN &[]EVI=LOPMENT DEPARTMENT LIB. No.: 656128
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
fcommenting with Section 7000} of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: -CIO, C29,License No.: 656128
Date: Z Contractor: _ 7a_-- 17
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
Da
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:
Date: 1/22/2019
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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 far which this permit is issued.
/'? I have and will maintain workets'tompensation 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 became subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 4 2z Applicant: / f b—c—
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 upon the above -
mentioned property for inspection purposes.
Date: ��Signature(Applicant orAgent): f f 1?GZ
Date: 1/22/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
BPOL2019-0008
80500 CHAMPIONS WY
775220021
GALLOGLY / POOL, AND BARBEQUE AT REAR YARD
$31,000.00
Owner:
GALLOGLY FAMILY TRUST
80500 CHAMPIONS WAY
LA QUINTA, CA 92253
Contractor:
TESERRA
P 0 BOX 1280
COACHELLA, CA 92236
(760)389-9222
Llc. No.: 656128
--------------------------------------------------------------------------------------------
Detail: POOL, AND [1] GAS FIXTURE AT REAR YARD [DOUGLAS FERRELL ENGINEERING] THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE.
ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION. 2016 CALIFORNIA BUILDING CODE.
DESCRIPTION
BSAS SB1473 FEE
DESCRIPTION
DEVICES, FIRST 20
DESCRIPTION
DEVICES, FIRST 20 PC
DESCRIPTION
SWIMMING POOL/SPA
DESCRIPTION
SWIMMING POOL/SPA PC
DESCRIPTION
RECORDS MANAGEMENT FEE
DESCRIPTION
TECHNOLOGY ENHANCEMENT FEE
ACCOUNT QTY
AMOUNT
101-0000-20306 0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$2.00
ACCOUNT QTY
AMOUNT
101-0000-42403 0
$26.68
ACCOUNT CITY
AMOUNT
101-0000-42600 0
$26.68
Total Paid for ELECTRICAL:
$53.36
ACCOUNT QTY
AMOUNT
101-0000-42404 0
$200.12
ACCOUNT CITY
AMOUNT
101-0000-42600 0
$108.87
Total Paid for POOL / SPA:
$308.99
ACCOUNT CITY
AMOUNT
101-0000-42416 0
$10.00
Total Paid for RECORDS MANAGEMENT FEE:
$10.00
ACCOUNT QTY
AMOUNT
502-0000-43611 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
QW�ev
GEN of,b, DptiCRT —
Project Address: 60 r66 aA714✓0161US ww
APN #:
Applicant Name: 6-
Address: 0 !�-66 MPl ol`ff w�'`
City, ST, Zip: �kF
22S
Telephone:
Email:
Contractor Name: %ESE'er—A
Address: A /D
City, St, Zip
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Tek I!, I I e: Sb .
Email: Il��I� rffe7fgot) F
State Lic:(,�(o /2� City Bus Lie:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie: City Bus Lic:
Property Owner's Name:
Address: &P/- 2
City, ST, Zip !00 6
Telephone:
Email:
PERMIT#
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
�G U , w+
valuation of Project S��
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Z251M Fire Sprinklers
Construction Type:
Grading:
Bedrooms:
SF
SF
SF
SF
Occupancy:
Stories: l # Units:
New Commercial / Tenant Improvements:
SF
Total Building
��,"nstruction Type:
Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY