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BELC2016-005253424 Avenida Martinez BELC2016-0052 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 Clas :, 1 Li rise No.: 965837 t40te: lf/ '^' Contractor. OWNER -BUILDER DE RAT I 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).: (_J 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 offeied 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 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: (760)272-.0837 Llc. No.: 965837 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' compe ation, as provided for by Section 3700 of the Labor Code, for the performance o t orJC-for which this permit is issued. I have and will maintain workers' compensation insurance, as required by SO, on 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and polity 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' co pe tion provisions of Section 3700 of the Labo e, I shall forthwith C. wi nth e p/ro)Ists. Date - " ` Applicant WARNING: FAILURE TO SECURE WORKERS' MPENS ON COVERAGE IS UNLAWFUL_, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN NALTIES 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 constructi , a dhereby authorize representatives of th' i enter u ie above -me itio d prttrty for inspection purposes. Date: COO Signature (Applicant or Age 0: C a' "'^ VOICE (760) 777-7125 78-495 CALLE TAMPICO D , LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT I Date: 6/6/2016 Application Number: Property Address: BELC2016-0052 Owner: 0 0 APN: 53424 AVENIDA MARTINEZ 774092025 PAMELA NELSON P 0 BOX 942 z L Application Description: NELSON / CHANGE OUT ELECTRICAL PANELS LA QUINTA, CA 92253 m o Z Property Zoning: o Application Valuation: $2,000.00 S ( O zC I Applicant: Contractor: O JOSEPH TROMBINO JOSEPH TROMBINO -0a m 38801 NELSON ROAD 38801 NELSON ROAD RANCHO MIRAGE, CA 92270 RANCHO MIRAGE, CA 92270 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 Clas :, 1 Li rise No.: 965837 t40te: lf/ '^' Contractor. OWNER -BUILDER DE RAT I 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).: (_J 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 offeied 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 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: (760)272-.0837 Llc. No.: 965837 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' compe ation, as provided for by Section 3700 of the Labor Code, for the performance o t orJC-for which this permit is issued. I have and will maintain workers' compensation insurance, as required by SO, on 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and polity 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' co pe tion provisions of Section 3700 of the Labo e, I shall forthwith C. wi nth e p/ro)Ists. Date - " ` Applicant WARNING: FAILURE TO SECURE WORKERS' MPENS ON COVERAGE IS UNLAWFUL_, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN NALTIES 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 constructi , a dhereby authorize representatives of th' i enter u ie above -me itio d prttrty for inspection purposes. Date: COO Signature (Applicant or Age 0: 'DESCRIPTION FINANCIAL INFORMATION 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 for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION :_ ACCOUNT QTY AMOUNT PAID PAID DATE SERVICES 101-0000-42403 0 $24.17 $0.00 PAID.BY METHOD • RECEIPT # CHECK # ' " CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SERVICES PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD RECEIPT # 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: NELSON / CHANGE OUT ELECTRICAL PANELS CONDITIONS Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 6/6/2016 SKH Approved: Parcel No: 774092025 Site Address: 53424 AVENIDA MARTINEZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 212 Lot: 16 Issued: . UNIT 20 EMAIL APPLICANT Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $2,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CONTRACTOR Details: CHANGE OUT ELECTRICAL PANEL. 2013 CALIFORNIA BUILDING CODES. 38801 NELSON ROAD Printed: Monday, June 06, 2016 4:08:17 PM 1 of 2 / ' Jai L] tJtJ SYSTEh1S CONDITIONS NAME TYPE -' NAME _ ADDRESS1 CITY STATE ZIP PHONE .: FAX . EMAIL APPLICANT JOSEPH TROMBINO 38801 NELSON ROAD RANCHO MIRAGE CA 92270 CONTRACTOR JOSEPH TROMBINO 38801 NELSON ROAD RANCHO MIRAGE CA 92270 OWNER PAMELA NELSON • P O BOX 942 LA QUINTA CA 92253 Printed: Monday, June 06, 2016 4:08:17 PM 1 of 2 / ' Jai L] tJtJ SYSTEh1S DESCRIPTION _ ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # . CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0- $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: SERVICES 101-0000-42403 0 $24.17 $0.00 SERVICES PC 101-0000-42600 0 $12.09 $0.00 Total Paid for ELECTRICAL: $36.26 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 INSPECTIONS PARENT PROJECTS BOND INFORMATION ATTACH M E NTS Printed: Monday, June 06, 2016 4:08:17 PM.2 of 2 N?SYSTEAAS i lN Bin #• Qlty of La Quinta Building &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ((Q Project Address: S3 v Owner's Name: ' A. P. Number: Address: 5342_4 & w /z, Legal Description: City, ST, Zip: Contractor: v (, d VW G ele hon Telephone: c: Address: Project Description: t& ::>::r: City, ST, Zip:. • t&&) +! f'f ( (/ S60 [A Te ne• le h Po . oW : State Lic. # : Sm City Lic. # (5 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: e ne: 0 Con tructi s on.T e• Occupancy: Y P cu ane Y: P State is # S te L. Project tYPa (circle one • New Add' n Alter e P air em 0 Name of Contact Person: li Sq. Ft.: Qt) # Stories: # Units: Telephone # of Contact Person: j %j Estimated Value of Project: Zad v APPLICANT: DO NOT WRITE BELOW THIS LINE # 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 tad 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:-. '"! Reyiew, 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