BELC2015-000178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
TESERRA
PO BOX 1280
COACHELLA, CA 92236
�4
�a�rw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BELC2015-0001
46910 HIGHLAND PALMS DR
643193006
NEW ELECTRICAL OUTLET
$530.00
JAN 0 8 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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: C--8, C27, C10, C29, C53 License No.: 656128
Date. 1-0 Contractor:
OWNER- ILDER 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 a
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 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 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
Date: 1/8/2015
Owner:
GIDEON COHN
46910 HIGHLAND PALMS DR
LA QUINTA, CA 92253
Contractor:
TESERRA
PO BOX 1280
COACHELLA, CA 92236
(760)398-9222
Llc. No.: 656128
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: _ 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 f h.
comply with those provisions.
Dateryl �%�—�� Applicant:
WARNING: FAILURE TO SECURE WORK 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: %"�S 'f Signature (Applicant or Agent):
G
,I
0 .
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
FORA NSTRUCTION
By
FINANCIAL i•
DESCRIPTION ACCOUNT
1
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 forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forELECTRICAL: $48.34 $0.00
DESCRIPTION
ACCOUNT
CITY
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
• 1 00
l..
Description: NEW ELECTRICAL OUTLET
CONDITIONS
Type: ELECTRICAL
Subtype: Status: UNDER REVIEW
Applied: 1/8/2015 PJU
Approved:
Parcel No: 643193006 Site Address: 46910 HIGHLAND PALMS DR LA QUINTA,CA 92253
Subdivision: TR 2117
Block: Lot: 20
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $530.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: NEW ELECTRICAL OUTLET FOR ABOVE GROUND PORTABLE SPA APPROVED BY ARMAN A. 2013 CALIFORNIA ELECTRCAL CODE.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITYSTATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
TESERRA
PO BOX 1280
COACHELLA
CA
92236
CONTRACTOR
TESERRA
PO BOX 1280
COACHELLA
CA.
92236
OWNER
GIDEON COHN
46910 HIGHLAND
PALMS DR
LA QUINTA
CA
92253
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 forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Thursday, January 08, 2015 2:27:19 PM
1of2
CRWSYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL: $48.34 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:0•
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS DATE NOTES
Printed: Thursday, January 08, 2015 2:27:19 PM 2 of 2
RWSYSTEMS .
Bin,#
City of La Q urn to .
Building &r Safety Division
P.O. Box 1504, 78 495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet//
Permit #
Project Address.
Owner's Name:
A. P. Number:
Address: 10 14i° A /,A VI
Legal Description:
City, ST, Zip:L C
Contractor: Te.-2 e ,-rc—• Gv I
Telephone:
Address:
Project.Description: A/e �[J� tr•�
City, ST, Zip: , C OG, C l.1e (
Cl—
r' G— if
Telephone: 76(1' 2, O 1
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,
State Lic. #
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
y:J: :
"` -%`'"` "`- '` '"'"' ''' "
....:.......................................:.........
Construction Type: Occupancy:
State Lic. #:
Project type circle one): �/e Add'n Alter Repair Demo
Name of Contact Person:So �
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rec'd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dccd
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
'rd Review, ready for eorrectionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees