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:
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Owner's Name: /,,5--0 j
A. P. Number:
Address: -.
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Legal Description:
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Project Description:
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State Lic. # : (
City Lie. #.:
Arch., Engr., Designer:
Address:
City., ST, Zip:
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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