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BELC2015-0031t 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: INDEPENDENT ELECTRIC 82-575 AVENUE 62 THERMAL, CA 92274 T4tit 4 4v Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BELC2015-0031 53733 AVENIDA OBREGON 774114021 G UTI E RREZ/RE LOCATE MAIN ELECTRICAL PANEL $2,000.00 . 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: C10 License No.: 936237 / 1 ' Dae: t�Y'� � 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 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, 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 Na Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: MARTHA GUTIERREZ P 0 BOX 583 LA QUINTA, CA 92253 Contractor: INDEPENDENT ELECTRIC 82-575 AVENUE 62 THERMAL, CA 92274 (760)578-4707 Llc. No.: 936237 Date: 4/22/2015 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. 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: _ 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.11 Le.'7" /S Applica< (: it /">" A,/%% ? Date 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 cit�tenter upon the ove- mentioned property for inspection purposes. - Date:' / Signature (Applicant or Agent)o C V z Ln d o aM 0 CV LL a. W9 LU Q C)` d c5 w o � v Q z C> o U 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. 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: _ 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.11 Le.'7" /S Applica< (: it /">" A,/%% ? Date 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 cit�tenter upon the ove- mentioned property for inspection purposes. - Date:' / Signature (Applicant or Agent)o C V CITY OF . QUINTA BUILDING & SAFEI-1 DEFT. ' APPROVED FOR CONSTRUCTION DATE ZZlo�S BY B`" # Qty of La Quinta Building 8r 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: Owner's Name: A. P. Number: Address: Legal_ Description: City, ST, Zip: Contractor: Telephone: Address: Project Description: City, ST, Zip: Telephone: State Lic. # : City Lic. #.- Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: ............................................ PancY Construction Type: Occupancy: • n'P i ) Repair Project a circle one): New Add'n Alter R air Demo J Name of Contact Person: Sq. Ft:# Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE 4 Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°° Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd 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 FINANCIAL•• • DESCRIPTION ;" = ; `ACCOUNT` ;` • -QTY " • , AMOUNT T{, PAID _, _ PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 ', PAID BY'• - "METHOD '. ;; " ;.•, ..RECEIP,T# `" ,`-- CHECK # . i.CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA ... x$1.00 $0.00 J DESCRIPTION ,' `:ACCOUNT.- QTY AMOUNT', PAID PAID DATE SERVICES 101-0000-42403 0 $24.17 $0.00 PAID:BY, - ...METHOD' * ,• RECEIPT'# CHECK #r_ CLTD BY 'DESCRIPTION ' ` ACCOUNT,. QTY ...'AMOUNT PAID PAID DATE SERVICES PC 101-0000-42403 0 $12.09 $0.00 PAID BY , « METHODv,.'RECEIP.T.# CHECK # "CLTD BY , Total Paid for ELECTRICAL: $36.26 $0.00 DESCRIPTION ACCOUNT ', QTY.. AMOUNT ' ._ PAID '. PAID DATE, PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY ,METHOD, RECEIPT # CHECK # CLTD BY, Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 Description: GUTIERREZ/RELOCATE MAIN ELECTRICAL PANEL Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 4/22/2015 SKH Approved: Parcel No: 774114021 Site Address: 53733 AVENIDA OBREGON LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 189 Lot: 11 Issued:. UNIT 19 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: ELECTRICAL- RELOCATE MAIN ELECTRICAL PANEL. 2013 CALIFORNIA BUILDING CODES. Printed: Wednesday, April 22, 2015 3:15:10 PM 1 of 2 CgT CYLV SYSTEMS CHRONOLOGY CONDITIONS CONTACTS NAME TYPE ' _: ; ' NAME=: ti:' •ADDRESS1' . ' • CITY • STATE. ZIP . PHONE FAX :EMAIL ' APPLICANT INDEPENDENT ELECTRIC 82-575 AVENUE 62 THERMAL CA 92274 CONTRACTOR INDEPENDENT ELECTRIC 82-575 AVENUE 62 THERMAL CA 92274 OWNER MARTHA GUTIERREZ P 0 BOX 583 LA QUINTA CA 92253 Printed: Wednesday, April 22, 2015 3:15:10 PM 1 of 2 CgT CYLV SYSTEMS r` DESCRIPTION: ; y ACCOUNT QTY AMOUNT PAID PAID DATE' 'RECEIPT # r.. CHECK # : METHOD . 'PAID BY CLTD „ BY SERVICES 101-0000-42403 0 $24.17 $0.00 SERVICES PC 101-0000-42403 .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:00 INSPECTIONS SEQID ` `' 1NSPECTIONTYPE--h; :-` INSPECTOR SCHEDULED COMPLETED_ .-""RESULT.'_ r REMARKS ;'ti , � �. ;NOTES `v ?_ k. DATE tDATES ELECTRICAL FINAL" BLD PARENT " PROJECTS REVIEWS RETURNED STATUS 4 REMARKS REVIEW TYPE ' REVIEWER;,",SENT DATE DUE DATE DATE' _ ', "NOTES .. •ND INFORMATION ATTACHMENTS Printed: Wednesday, April 22, 2015 3:15:10 PM 2 of 2 CLAW - SYSTEMS Bin # , City of La Quinta Building 8t: Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Permit # Z'Dl�j Project Address: 37 3 3 �U �� �� 6� Owner's Name: f V G a.r (�. e. e 2 A. P. Number: Address: .-53'12 3 d n Legal. Description: City, ST, Zip: SJ Contractor . Telephone: Address: -7 d E Project Description: / !� City, ST, Zip: CA 7 1 Telephone:66• 7'7a State Lic. # : City Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: one: .................................. Co tru i ns ct on T e• Occupancy: State Lic. #:Project type (circle one): New Alter Repair Demo Name of Contact Person: I Sq. Ft.: # Stories: # Units: .Telephone # of Contact Person: _ Estimated Value of Project: 0 APPLICANT: DO NOT WRITE BELOW 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 21" Review, ready for correctionsrissue Electrical " Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' 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 .