BELC2015-0004c&t,, 4 44�&rcv.
78-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2015-0004
Property Address:
52140 AVENIDA OBREGON
APN:
773215007
Application Description:
ELECTRICAL PANEL CHANGE OUT
Property Zoning:
Application Valuation:
$900.00
Applicant:
MOX ELECTRIC
FF
54225 AVENIDA MENDOZA AN j'g ZoiS
LA QUINTA, CA 92253
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.
LicenseClass: _ License No.::LIC -0107359
D /
ate: ! Contractor:
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 Divisi
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 fo a
permit subjects the applicant to,a civil penalty of not more than five hundred dolla s
($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. BAP.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 N
Lender's Address:
�r
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
q
Owner:.
MAI HAYES
52140 AVENIDA OBREGON
LAIQUINTA, CA 92253
Contractor:
MOX ELECTRIC
54225 AVENIDA MENDOZA
LA QUINTA, CA 92253
(760)567-3660
Llc. No.: :LIC -0107359
Date: 1/13/2015
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
of the work for which this permit is issued.
1 -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: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 upon the above-
mentioned property for inspection, purposes.
Date: Signature (Applicant or A -
t:yA'
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`` 'ACCOUNT a tQT1fXY. AMOUNT~; °PAID: ��
'.'•'s#.!a'na3x.:atew:>�vetaxr�.t
t;PAID,DATEx
_
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101-0000-20306. 0 y $1r00 $0AQ
BSAS SB1473 FEE
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Total Pa;id.forBUILDING STANDARDS ADMINISTRATION 13., $100 $0:00
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SERVICES
;. 101=0000 43403`
0 +
$24%17
$0.00
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$0.00
SERVICES PC
" 101-0000 42403
.
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;[fpr PAID. BY_'•
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"METHOD r"�
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, Total Paid for'ELECTRICAL: $36:26 $0.00
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PERMIT ISSUANCE :
101=0000 42404$0.00
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C:'.: yPAID,tltBY ,,.''°:��h}y,-�y,,§t'. ,
i'',"idi�l;.}aar.$.7)..:*;:..'u,uVx.'»;kt7°,f,G?�C`:h'eh,`si.:a'?Y,r!?..2Car::tr�#��,.!�:fehG9Y
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- , t Notal Paid'forP,ERMIT`�ISSUANCE� y,, i� ; $0 00:
e ��,$91:85
Description: ELECTRICAL PANEL CHANGE OUT
Type: ELECTRICAL Subtype: Status: UNDER REVIEW
Applied: 1/13/2015 PJU
Approved:
Parcel No: 773215007 Site Address: 52140 AVENIDA OBREGON LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 1 Lot: 7
Issued:
UNIT 1
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $900.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: CHANGE:OUT EXISTING PANEL CHANGE OUT OLD PANEL 200 AMP TO NEW TITLE 24 200 AMP'MAIN.PANEL 2013 CALICO RNIA
ELECTRICAL CODE.
APPLICANT
MOX ELECTRIC
54225 AVENIDA
LA QUINTA
CA
92253
MENDOZA
CONTRACTOR
MOX ELECTRIC
54225.AVENIDA
LA QUINTA
CA
92253
MENDOZA
OWNER
MAI HAYES
52140 AVENIDA
LA QUINTA
CA
92253
OBREGON
FINANCIAL INFORMATION
Printed: Tuesday, January 13, 2015 4:32:01 PM 1 of 2
SYSTEMS
or
77
m,D
-66610416W:
7,
7777777
ACCOUNT
CITY
AMOUNT
PAIQ`
PAID DATE
ECEI
HE K
-B
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
SERVICES
101-0000-42403
0
$24.17
$0.00
SERVICES PC
101-0060-42403
0
$12.09
$0.00
Total Paid forELECTRICAL: $36.26 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85, $0.00
TOTALS: $129.11 $0.00
Printed: Tuesday, January 13, 2015 4:32:01 PM 2 of 2
q.ovrW.,YST,mS
Bin #
Qty of la Q grin to . .
Building St• Safety Division
P.O. Box 1-504, 78-495:Calle Tampico .
La Quihta, CA 92253.-:(760).777-70,12
Bdiiding�Permit Application and Tracking Sheet
Permit #
Project Address:
Owner'sName:� 1 mss'
A. P. Number:
`Address: 5 U /li "PIq ® ��
Legal Description:1x— -
City, ST,Zip: LA Q
Pc J�
Contractor: U� C
Telephone:
ne:
Address:. 5,(( 2'� �� G+�lPnl �02�
Project:Descriptiom. Cha . LhCi t L<- rn,5 •il
City, ST, Zip: Z--6 V % /v
00.' ..
Telephone: �J�O `j'�%%„��G' �•
:>z::;::%o
.;Z. �A /� �Q�'P
State Lie. #
City. Lia #•! ..,,
Arch., Engr., Designer: /
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
ddt
n Alter Repair DemoJect. �Pa circle one
State Lie. #:
Name of Contact Person:
•'Sq.;FC:`""/a
#.Stories:
# Units: 1
Telephone #,of Contact Person:
Estimated Value of Project: j Od
'APPLICANT: DO NOT WRITE BELOVTHIS LINE
#
Submittal
Rcq'd
Rcc'd
TRACICING,
PERMIT FEES.
Plan Sets
Plan Check submitted'
Item
Amount
Structural Calcs.
Revicwcd;.rcady for corrections
t
:Plan Check Deposit
Truss Calcs.
Called.ContacilPces6n .
Plan Check Balance.
Title 24 Calcs.
"Plans picked up.z,.
Construction
Flood plain plan
Plans resubmitted-
1
Mechanical
Grading plan
2°" Revicw; ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans oicked;up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`' Rcyiew; ready for eorrcctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Datc of permit issue
School Fees
Total Permit Fees