BELC2016-004578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
.T 4.4aw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2016-0045
Property Address: 52615 AVENIDA DIAZ
APN: 773281018
Application Description: DHANDHO RES RENTAL / CHANGE OUT 200 AMP PANEL
Property Zoning:
Application Valuation: $1,200.00
Applicant:
GIBBS BROS ELECTRIC CO INC •
P 0 BOX 31021
LOS ANGELES, CA 90031-0021
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.: 169324
J / f l
Date: 7 Z10/0 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).:
I ) 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 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
(323)225-5945
Llc. No.: 169324
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 or for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 00 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: .� ^I G' Z04 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.
r ,-
Date: --/G-gnature (Applicant or Agent):
Date: 5/16/2016
Owner:
FIRST REGIONAL BANK
.�.
10 PROSA
IRVINE, CA 92253
C-3
rri C>G
Contractor:
�X
GIBBS BROS ELECTRIC C
L0 BOX 31021
OS ANGELES, CA 90031�I1D'
(323)225-5945
Llc. No.: 169324
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 or for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 00 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: .� ^I G' Z04 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.
r ,-
Date: --/G-gnature (Applicant or Agent):
t5
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
tot't1
Description: DHANDHO RES RENTAL / CHANGE OUT.200 AMP PANEL
CONDITIONS
Type: ELECTRICAL Subtype:
Status: UNDER REVIEW
Applied: 5/16/2016 SKH
Approved:
Parcel No: 773281618 Site Address: 52615 AVENIDA DIAZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 166
Lot: 5
Issued:
UNIT 17
NAME TYPE
NAME
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $1,200.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
GIBBS BROS ELECTRIC CO INC
Details: CHANGE OUT 200AMP ELECTRIC PANEL. 2013 CALIFORNIA BUILDING CODES.
LOS ANGELES
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
GIBBS BROS ELECTRIC CO INC
P 0 BOX 31021
LOS ANGELES
CA
90031-
0021
alromo@gmail.com
CONTRACTOR
GIBBS BROS ELECTRIC CO INC
P 0 BOX 31021
LOS ANGELES
CA
90031-
0021
alromo@gmail:com
OWNER
FIRST REGIONAL BANK
10 PROSA
IRVINE
CA
1.92253.
FINANCIAL INFORMATION
Printed: Monday, May 16, 2016 2:05:55 PM 1 of 2
SYSTEnAS
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
BSA: $1.00• $0.00
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
TOTALS:
PARENT PROJECTS
Printed: Monday, May 16, 2016 2:05:55 PM 2 of 2 ,
srsrrnas
C
>3» #. - -
City of La Quinta
Building 8t Safety Division
78-495 Calfe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Z S- • Ave^ ^ fl�� z • 1�'-
Owner's Name: FK
A. P. Number:
Address: Z. % 3 -] Z
Legal Description:
;City, ST, Zip: <a,t C t VIA,, G L et
Co tractor: /. ll 1
C.st b L
y. b r r
-5
Tele h n
P o e.
Address: 003 s. �-, r
-
Project Description:
it
City, ST, Zip-. S o
i`
Te le h ne-
P 0 2 2
3�2
2-
State
State Lic. 4: W 3 Z H
City Lic. #.:�-
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: e.
Contructi
s on Type: P an
Occupancy:
Y cY:
Lic. #:
Project tYPa �citcle one) • New Add'n Alter Repair
Demo
_
Name of Contact Person: /� �y
Sq. Ft.:
# Stories:
# Units:
:Telephone # of Contact Person: �%lj ( 1Y:5 8 % (
Estimated Value of Project: 200 Co
APPLICANT: DO NOT WRITE BELOW THIS LINE
t/
Submittal
Req'd
Rec'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 HOUSE:-
'"! 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
�,/ L. /'.
715—