BELC2015-005751775 Avenida Madero
BELC-0057
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
KELLNER, JEFFREY F.
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
Titit 4 4 Qu&&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BELC2015-0057
51775 AVENIDA MADERO
773153013
ELECTRICAL METER RELOCATE UPGRADE
$1,000.00
A
JUL 3 0 201
CITY OF LA QUINTA
COMMUNITY DEVELOOMENT DEI
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: _ License No.: :LIC -0105348
Date: / Contractor:
OWNER -B E CLARATION
I hereby affirm under penalty of perjury t t 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 Divisiory`
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
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 Name
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/30/2015
Owner:
ETHAN GRANT
51775 AVENIDA MADERO
LA QUINTA, CA 92253
Contractor:
KELLNER, JEFFREY F.
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
(760)774-5330
Llc. No.: :LIC -0105348
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 37 f he Labor Co e, I shall forthwith
cco mply with t/hqSe provisions.
'Bate: 7/J4d/ / Applica - '40
WARNING: FAILURE TO SECURE WORK OMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYE 0 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 tko above-
mentioned pr pert for inspection purposes.
)iilto Signature (Applicant or Agent): _ W4L,
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00
$0.00
PAID BY METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
POWER APPARATUS
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
POWER APPARATUS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $48.34 $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: ELECTRICAL METER RELOCATE UPGRADE
CONDITIONS
Type: ELECTRICAL Subtype:
Status: UNDER REVIEW
Applied: 7/30/2015 PJU
Approved:
Parcel No: 773153013 Site Address: 51775 AVENIDA MADERO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 30
Lot: 1
Issued:
UNIT 2
NAME
ADDRESSI
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type:'
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
LA QUINTA
Details: ELECTRICAL PANEL UPGRADE 125 AMP TO 200 AMP ELECTRICAL PANEL RELOCATION APPROVED PER IID & BH. 2013 CEC
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX EMAIL
APPLICANT
KELLNER, JEFFREY F.
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
(760)774-5333
CONTRACTOR
KELLNER, JEFFREY F.
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
(760)774-5333
OWNER
ETHAN GRANT
51775 AVENIDA
MADERO
LA QUINTA
CA
92253
(760)774-5333
DESCRIPTION I ACCOUNT I QTY I AMOUNT
PAID I PAID DATE I RECEIPT # I CHECK # I METHOD
BSAS SB1473 FEE 1 101-0000-20306 1 0 $1.00 $0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
LTD
PAID BY I CBY
BY
Printed: Thursday, July 30, 2015 9:47:36 AM 1 of 2 CRWYSrEMS
Permit Details PERMIT NUMBER
CityofLa Quinta BELG2,015=0057
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
POWER APPARATUS
101-0000-42403
0
$24.17
$0.00
POWER APPARATUS PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
PERMIT ISSUANCE
101-0000-42404
1 0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 .$0.00
TOTALS:00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
ELECTRICAL FINAL" BLD
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Thursday, July 30, 2015 9:47:36 AM 2 of 2 cg?wSYSTEMS
BOND
INFORMATION
ATTACHMENTS
Printed: Thursday, July 30, 2015 9:47:36 AM 2 of 2 cg?wSYSTEMS
Bin #
City of La Quinta
Building 8Z 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 Addres/— 7 d Joe. .6
Owner's Name:< n
A. P. Number:
Address:S1
Legal Description:
City, ST, Zip
Contract
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Tel ePhon e. -! J
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Project Description:
City, ST, Zip:
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Telephone • / r
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State Lic. #
t City Lic. #:
. 7 44,__ 2
Arch., Engr., Designer:
Address:
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City, ST, Zip:
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Construction struction TYP e: O u anc
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State Lic. . #
Project type (circle one): New Add' n Alter ai e m o
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
r,
APPLICANT: DO NOT WRITE BELOW THIS LINE Ov d
t!
Submittal
Req'd
Ree'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
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 ROUSE:-
"'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
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