BELC2014-102378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,d4r44Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BELC2014-1023 .
Property Address:
78932 HIGHWAY 111
APN:
643080009
Application Description:
ADDING ELECTRICAL RECEPTACLES
Property Zoning:
Application Valuation:
$1,500.00
Applicant:
SUPERIOR ELECTRICAL MECHANICAL
OUT OF CITY LIMITS
SEP 15 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPAFMjENT
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 Divi ' 3 of the Business a d Profess' s Code,
and my License is in full force and effect.
License Class: _ License N, :LIC -76 80
Dater Contractor:
OWNER -BUILDER DECLATION
I hereby affirm under penalty of perjury that I am exe pt 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 ?
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 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 Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/15/2014
Owner:
TACO BELL 142659
78932 HIGHWAY 111
INDIO, CA 92253
Contractor:
SUPERIOR ELECTRICAL MECHANICAL
OUT OF CITY LIMITS
Llc. No.: :LIC -762280
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 polity 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 gr that, i houl eco me s ' ct to the
workers' compensation provisions of
doth
of
La
ode I sh I forthwith
comply with hose provisions.
Date: y Applic
WARNING: FAILURE TO SECURE WORKERS' COMP NSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES 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 applicationand stat t the above information
I agree to comply with all city and county ordina ces d sta a e in
construction, and hereby authorize representativ oft ' C-11 to ente on
mentioned property for inspection purposes.
Date: EI �+gnature (Applicant or A n
i
DESCRIPTION ,;;
FINANCIAL INFORMATION
ACCOUNT
CITYAMOUNT
PAID
PAID DATE-
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
9/15/14
PAIDBY
METHOD '
RECEIPT #
CHECK #
CLTD BY
SUPERIOR ELECTRICAL MECHANICAL
CHECK
R1165
3587
KHE
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA
$1.00
$1.00
DESCRIPTION ;'
ACCOUNT
QTY
"' AMOUNT
PAID
PAID.DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
9/15/14
PAID BY ` `
METHOD
RECEIPT #
CHECK #
CLTD BY
SUPERIOR ELECTRICAL MECHANICAL
CHECK
R1165
3587
KHE
DESCRIPTION,.. '.
';AMOUNT
ACCOUNT : _.:.
QTY
.'.
PAID
PAID DATE -
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
9/15/14
PAID BY
METHOD
'RECEIPT
CHECK#,.,
CLTD BY;,,
SUPERIOR ELECTRICAL MECHANICAL
CHECK
R1165
3587
KHE
Total Paid forELECTRICAL:
$48.34
$48.34
>DESCRIPTION :'
ACCOUNT
QTY
AMOUNL, `
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
9/15/14
PAID: BY
METHOD
RECEIPT.#
CHECK#
CLTD BY
SUPERIOR ELECTRICAL MECHANICAL
CHECK
R1165
3587
KHE
Total Paid forPERMIT ISSUANCE:
TOTALS:
$91.85
$91.85
Description: ADDING ELECTRICAL RECEPTACLES
Type: ELECTRICAL
Subtype: Status: APPROVED
Applied: 9/15/2014 KHE
Approved: 9/15/2014 KHE
Parcel No: 643080009 Site Address: 78932 HIGHWAY 111 LA QUINTA,CA 92253
Subdivision: PM 25865
Block: Lot: it
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,500.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
NAME
Details: REPLACE 2 - 20 AMP 220V OUTLETS AND 2 - 30 AMP 110 V OUTLETS
CITY STATE ZIP PHONE FAX EMAIL
Printed: Monday, September 15, 2014 1:38:48 PM 1 of 2
SYSTEMS
ADDITIONAL
CHRONOLOGY
CONDITIONS
•0 1 IF -A
NAME TYPE
NAME
ADDRESSI
CITY STATE ZIP PHONE FAX EMAIL
APPLICANT
SUPERIOR ELECTRICAL MECHANICAL
OUT OF CITY LIMITS
CONTRACTOR
SUPERIOR ELECTRICAL MECHANICAL
OUT OF CITY LIMITS
OWNER
TACO BELL 142659
78932 HIGHWAY 111
INDIO CA 92253
Printed: Monday, September 15, 2014 1:38:48 PM 1 of 2
SYSTEMS
Printed: Monday, September 15, 2014 1:38:48 PM 2 of 2
SYSTEti1S
a1)
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
:.
BY
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
9/15/14
R1165
3587
CHECK
SUPERIOR ELECTRICAL
KHE
MECHANICAL
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
9/15/14
R1165
3587
CHECK
SUPERIOR ELECTRICAL
KHE
MECHANICAL
Total Paid for ELECTRICAL:
$48.34
$48.34
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
9/15/14
R1165
3587
CHECK
SUPERIOR ELECTRICAL
KHE
MECHANICAL
Total Paid for PERMIT ISSUANCE:
$91.85
$91.85
TOTALS:
$141.19
$141.19
INSPECTIONS
SEQID INSPECTION TYPE .: _INSPECTOR
SCHEDULED COMPLETED
RESULT
REMARKS
NOTES
DATE
DATE
ELECTRICAL FINAL"
Printed: Monday, September 15, 2014 1:38:48 PM 2 of 2
SYSTEti1S
a1)
�✓�
Bin #
-City- of La Quinta
Building h' &r Safe Division
9 P.O. Box 1504, 78-495 Calle Tampico.
l La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Owner's Name:
A. P. Number: Address:
Legal on: City, ST Zip:
Contra or: ,,nn r � :`-s'«':»>r�<<'r<ss">`:.�rr>`•«
l`^ e -' >°
Addr&6 L G Project Description:
City, ST, L
Tele c: �� �'G�
<n ":._.<.:::;•;<%:><>%>;:>;>>: :`:%< c�
State Lic. # : l Ll g City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: :.?:<::><:":>=«<r::>:<:z<
P Construction Type: Occupancy:
State Lic. #: =~''=`'' >`--<>_•, -• » >>^ h'Pa (circle circle one : New Addn Alter
J ) ' Repair Demo
Name of Contact Person , Sq. Ft.: # Stories: # Units:
Telephone # of Contact PersodQM L44 Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural C31eS.
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 correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
J