BELC2016-005677651 Los Arboles Dr
BELC2016-0056
78-495 CALLE TAMPICO I 0 U VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/27/2016
Application Number: BELC2016-0056 Owner: _
Property Address: 77651 LOS ARBOLES W BERTKE D n
APN: 658260016 P 0 BOX 176424 [
Application Description: PAUL BURKER / MAIN BRAKER CHANGE OUT FORT MITCHELL, KY 92253,
Property Zoning: JUN 2 7 2016
Application Valuation: $500.00
CITY OF LA OEN
Applicant: Contractor:
COMMUNIT D- EIN _I
P` q -BENT
COULTER ELECTRIC INC COULTER ELECTRIC INC
78078 COUNTRY CLUB #202 78078 COUNTRY CLUB #202
BERMUDA DUNES, CA 92203 ` BERMUDA DUNES, CA 92203
(760)660-2838
Llc. No.: 957021
-----------------
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: License No.: 957021
Date: t— V-4 Contractor:ef-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).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intehded 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. Q.
Lender's
Lender's
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 th 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, 1 shall forthwith
comply with those provisions. { //►
Date: Applicant:
2G ,!<
WARNING: FAILURE TO SECURE WORKER COMPE ATIO ERAGE 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. 1 it
Date: 27 L Signature (Applicant or Agent)
INFORMATION
DESCRIPTION ACCOUNT. QTY : AMOUNT .
PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00
$1.00 6/27/16
PAID BY METHOD
RECEIPT #
CHECK # CLTD BY
BOB SHANNON DEBIT
R16601
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
6/27/16
PAID BY
METHOD.
RECEIPT #
CHECK #
CLTD BY
BOB SHANNON
DEBIT
R16601
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
r $24.17
$24.17
6/27/16
PAID BY
METHOD
•RECEIPT #
CHECK #
CLTD BY
BOB SHANNON
DEBIT
R16601
RSE
Total Paid for ELECTRICAL:. $48.34 $48.34
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/27/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
BOB SHANNON
DEBIT
R16601
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS: $141.19 $141.19
Description: PAUL BURKER / MAIN BRAKER CHANGE OUT. .
•
NAME TYPE NAME
Type: ELECTRICAL Subtype:
Status: APPROVED
Applied: 6/27/2016 RSE
Approved: 6/27/2016 RSE
Parcel No: 658260016 Site Address: 77651 LOS ARBOLES LA QUINTA,CA 92253
Subdivision: TR 14496-1 & INT IN COMMON AREAS Block:
Lot: 82
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
92203
Details:: CHANGE OUT 200 AMP MAIN BREAKER. 2013 CALIFORNIA BUILDING CODES
ADDITIONAL SITES
CHRONOLOGY
•
NAME TYPE NAME
ADDRESSI
•
CITY STATE
ZIP
PHONE FAX
EMAIL
APPLICANT COULTER ELECTRIC INC
78078 COUNTRY CLUB
#202
BERMUDA CA
DUNES
92203
CONTRACTOR COULTER ELECTRIC INC
78078 COUNTRY CLUB
#202
BERMUDA CA
DUNES
92203
OWNER W BERTKE
P 0 BOX 176424
FORT MITCHELL KY
. 92253
Printed: Monday, June 27, 2016 10:15:59 AM 1 of 2 C
SYSTEMS
DESCRIPTION
ACCOUNT ..
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
•
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/27/16
R16601
DEBIT
BOB SHANNON
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
6/27/16
R16601
DEBIT
BOB SHANNON
RSE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
1 6/27/16
R16601
DEBIT
BOB SHANNON
RSE
Total Paid for ELECTRICAL: $48.34 $48.34
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/27/16
1 R16601
DEBIT
BOB SHANNON
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS: $141.19 $141i19
INSPECTIONS
ATTACHMENTS
Printed: Monday, lune 27, 2016 10:15:59 AM 2 of 2 C1
' SYSTEi41S
Bin #
City of La Q uin to
Building 8i Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
S Building Permit Application and Tracking Sheet
Permit #
Project Address: .
Owner's Name:
A. P. Number:
Address:
J
Legal Description:
City, ST, Zip:
ontra r:
C ct o 2r L Q
T h n
ele o e.
P G7 f'
Address: Q aUa
Project Description: v,
City, ST, Zip: , !
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Telephone:
6 v
State Lic. #: 01 S 7 O City Lie. #.:.-7/az % 3
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
..........................................<.:.
Construction TYPe: Occupancy:
aneY:
State L ic.#•
Project tYPa (circle one):. New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
bmittal
Req'd
Recd
TRACEING
PERMIT FEES
ft
an Sets
Plan Check submitted
Item
mount
ructural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check ante
Title 24 Cales.
Plans p d up
Co ruction
Flood plain plan
Plans resubmitte
Mechanical
Grading plan
2" Review, ready for correc ' nsfiss
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
i
Plans picke
S.M.I.
H.O.A. Approval'
ubmitted
ding
IN HOUSE:-
r`- Review, ready for corrections/issue
elop Impact Fee
PA
Planning Approval
Called Contact Person
P.P.
Pub. Wks. A;;;;r
Date of permit issue
Sc Fees,
Total Permit Fees