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BELC2016-005778-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: LONG ELECTRIC'INC P 0 BOX 901 LA QUINTA, CA 92253 T4ht 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BELC2016-0057 52835AVENIDA NAVARRO 773334018 LISA MADRIGAL /ELECTRICAL PANEL REPLACEMENT $1,000.00 JUN 27 2016 CITY QF LA QUINTA f�k1t'LfUNRY DEVELOPMENT DEPAr TMENT 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: C10 License No.: 521931 Date: -Z-7— Iiir '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 I, as owner of the property, or my employees with wages as their sole compensation, will do thework, 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 Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/27/2016 Owner: LISA MADRIGAL , 92253 Contractor: LONG ELECTRIC INC P 0 BOX 901 LA QUINTA, CA 92253 (760)568-4753 Llc. No.: 521931 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 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. Date: _ —?-7*­-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 Agent): FINANCIAL • ' • .DESCRIPTION '' n: > ACCOUNft 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 LONG ELECTRIC INC CHECK R16608 5734 RSE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:, $1.00 $1.00 : DESCRIPTION ' ACCOUNT.' QTY. AMOUNTPAID PAID DATE SERVICES 101-0000-42403 0 $24.17 $24.17 6/27/16 PAID BY, METHOD- >; .:. RECEIPT # CHECK # CLTD BY ; LONG ELECTRIC INC CHECK R16608 5734 RSE DESCRIPTION ACCOUNT QTY µ AMOUNT r PAID PAID DATE: SERVICES PC 101-0000-42600 0 . $12.09 $12.09 6/27/16 , PAID BY METHOD RECEIPT #, CHECK # . CLTD BY LONG ELECTRIC INC CHECK R16608 5734 RSE .Total Paid for ELECTRICAL: $36.26 $36.26 DESCRIPTION ACCOUNT QTY 'AMOUNT " PAID _ PAID DATE PERMIT ISSUANCE 101-000042404 0 $91.85 $91.85 6/27/16 PAID BY - METHOD RECEIPT #.: CHECK # CLTD BY LONG ELECTRIC INC. CHECK R16608 5734 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 Description: LISA MADRIGAL /ELECTRICAL PANEL REPLACEMENT ADDITIONAL Type: ELECTRICAL Subtype:. Status: APPROVED Applied: 6/27/2016 RS Approved: 6/27/2016 RSE Parcel No: 773334018 Site Address: 52835 AVENIDA NAVARRO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 148 Lot: 5 Issued: UNIT 15 NAME TYPE Lot Scl 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 LONG ELECTRIC INC Details: ELECTRICAL PANEL REPLACEMENT 100 AMP. 2013 CALIFORNIA BUILDING CODES CA 92253 Printed: Monday, June 27, 2016 12:35:53 PM 1 of 2 SYS7Eti1S ADDITIONAL CHRONOLOGY • • NAME TYPE NAME '` : CONTACTS ADDRESS -1 CITY STATE ZIP PHONE FAX EMAIL APPLICANT LONG ELECTRIC INC P O BOX 901 LA QUINTA CA 92253 CONTRACTOR LONG ELECTRIC INC P 0 BOX 901 LA QUINTA CA 92253 OWNER LISA MADRIGAL 92253 Printed: Monday, June 27, 2016 12:35:53 PM 1 of 2 SYS7Eti1S J DESCRIPTION -`ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK #;.' METHOD PAID BY CLTfS. BY SERVICES 101-0000-42403 0 $24.17 $24.17 6/27/16 R16608 5734 CHECK LONG ELECTRIC INC RSE SERVICES PC 101-0000-42600 0 $12.09 $12.09 6/27/16 R16608 5734 CHECK LONG ELECTRIC INC RSE Total Paid for ELECTRICAL: $36.26 $36.26 PERMIT ISSUANCE 101-0000-42404 0 • $91.85 $91.85 6/27/16 R16608 5734 CHECK LONG ELECTRIC INC RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: $129.11 $129.11 PARENT PROJECTS Printed: Monday, June 27, 2016 12:35:53 PM 2 of 2 , SYSTEMS Bin # LO 57Building City of La Quin to Building &• Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Permit Application. and Tracking Sheet Permit # Project Address: 6kq_�lw,fb Owner's Name: /,,5--0 j A. P. Number: Address: -. a Legal Description: City, ST, Zip: qa', Contra t r. vTele hone• _ 6 U Emma Address: akz) e, qGr Project Description: City,.ST, Zip: P� L yy t T /it ele hone• (d P � 6L7 State Lic. # : ( City Lie. #.: Arch., Engr., Designer: Address: City., ST, Zip: hone: Telephone: Construction Type: Occupancy:cY : ai # State Lie. Pro ect type Al Alter Repair Demo J Pi ) a circle one): New Add'n to P Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: V U 0 APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd TRACKING PERMIT FEES Plan Se Plan Check submitted Item ount Structural Calcs Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Bal ce Title 24 Cales. Xlans picked up Constr ion Flood plain plan Plans ubmitted Nfrchanical Grading plan 2qd Review, rea or 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:- '"! Reviev,,dy for corrections/issue eveloper Impact Fee Planning Approval C Contact Person A.I.px Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees