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BELC2016-009378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: BELC2016-0093 T-,itlt 4 XP Q" DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT 78395 GOLDEN SANDS PL 643193009 MILEY RESIDENCE / ELECTRICAL $2,000.00 Applicant: COULTER ELECTRIC INC 78078 COUNTRY CLUB #202 BERMUDA DUNES, CA 92203 I 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. I License Class: C10 License No.: 957021 Date:"f' ^ =Contractor: P C 7 OWNER -BUILD R DECLAR 10 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 const uct, 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, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stru':ture 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 ( I I am exempt under Sec. . B.&P .C. for this reason I 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: l Lender's 0 60) 777-7125 F 60)777-7011 INSp',�CTIONS 0)�7j`-7153 oFs/%:0401,11)'031- �v////I � 11vi" *1� / Owner: DENISE MILEY F�O,o�QG��y1q 8395 GOLDEN SANDS PL /1/T LA QUINTA, CA 92253 �S10, lk- Contractor: COULTER ELECTRIC INC 78078 COUNTRY CLUB #202 BERMUDA DUNES, CA 92203 (760)660-2838 Llc. No.: 957021 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9150873 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 th Labor Code, I sh II forthwith comply with those provisions. Date: &— �' `6- 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 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: G!— �(�� ( Signature (Applicant or Agent) Application Number: BELC2016-0093 Property Address: 78395 GOLDEN SANDS PL APN: 643193009 ! Application Description: MILEY RESIDENCE / ELECTRICAL Property Zoning: Application Valuation: $2,000.00 Applicant: COULTER ELECTRIC INC 78078 COUNTRY CLUB #202 BERMUDA DUNES, CA 92203 Date: 11/10/2016. Owner: DENISE MILEY 78395 GOLDEN SANDS PL LA QUINTA, CA 92253 Contractor: COULTER ELECTRIC INC 78078 COUNTRY CLUB #202 BERMUDA DUNES, CA 92203 (760)660-2838 Llc. No.: 957021 --------------------------------------------------------------------- Detail: ELECTRICAL PANEL UPGRADE. 100 AMP TO 200 AMP.. REMAINING IN SAME LOCATION. PER 2013 CALIFORNIA BUILDING CODE FINANCIAL INFORMATION DESCRIPT ON ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPT ON ACCOUNT QTY AMOUNT SERVICES 101-0000-42403 0 $25.33 DESCRIPT ON ACCOUNT QTY AMOUNT SERVICES PC 101-0000-42600 0 $12.67 Total Paid for ELECTRICAL: $38.00 DESCRIPT ON ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 t e�(Sc(OA) loo !J (OC,41 fov ,o NGw 26o Art 0 �v ul I Y OF UA QUINTA BUILDING & SAFETY DEPT. AP O 5d L FOR CONSTRUCTION DATE �, 1 %� BY ►' V O� �; Iain ff , City of 1a Quin ta Building &r Safety Division Permit u 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7011 Building Permit Application and Tracking Sheet ,,Project Add ss: O's Name: r) O G�'.•�.(,( wner A. P. Number: CAddress: A's 0=5 Lego[ Description: .. ^City, ST, Zip:5 ^ — Contractor. .P r l ? L• -� c Tle h n e P o c. Address:1 do � '� Ll d �(o �r� 'Project Description: City, ST, Zip: f ��K _. — -- (Jb b . AWk c 1/1 Vl a Telephone: _ State Lic. # : S City Lic. #c Arch., Engr., Designer: Address: City, ST, Zip: Tele h ono an Construction Occupancy: TYPe- ey: State Lic. V Project type (circle one): New. Add'n Alter Repair. Demo TameC of itac:t Person Sq. Ft.: -T# Stories: # Units: `Telephon4of Contact Person:Estimated Value of Project: 2 a APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Rcq'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit ' Truss Cafes. Called Contact person Plan Check Balance Tit!e 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Revicw, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Dced Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN If OUSE:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. IN'ks- Appr Date of permit issue School Fees, Total Permit Fees