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BELC2015-011078-495 CALLE TAMPICO D LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: BELC2015-0110 1111111 IIIII IIII IIII Owner: Property Address: 49823 ADELITO DR 18 LOUIS BURR APN: 646250002 P 0 BOX 1901 Application Description: ONEILL / ELECTRICAL PANEL C AN6E-OUT --------------n LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,500.00 Applicant: DEC 16 2015 Contractor: MENDOZA ELECTRIC MENDOZA ELECTRIC 50-313 CALLE TOLOSA 50-313 CALLE TOLOSA COACHELLA, CA 92236 CITY 06- L'Qt,' , A COACHELLA, CA 92236 COMMUNITY DEVEL0PMFNT DEBAR T MEPJT (760)404-7214 LIC. No.: 904511 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.: 904511 Date: 1 Z —1 b- t S Contractor: OJA 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 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.). (1 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 Name: Lender's Date: 12/16/2015 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. C�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: - .1 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: b CK-_ Applicant: �p 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 asa 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): Yi DESCRIPPION - W ACCO lPAID PAID AD TES FAMOUNT}' 1814 .' a.r :ms :. - ,-.n'e.45; :F,C,i:r..: .., :•'11-135�445°SBY1473-FEE 101-0000-20306 - 0 $1.00 $0.00 'N -%, Yr �' " f , 4 '. � . t ��e;PAIDBY +i': '? ' '�*,�' R.z �"x CHECK,# F141ni `' MExHOD`"RECEIPT# �CLTDBY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 `Hx� DESCFtIPTION�& 1 y' ADCC U T '3� QTY A O NT PAID E PAID DATE �,:.,; .r.,��fix.s;.:,ri. he.✓h. '?iwi .^`t`v":-y ,6'<;9:d.rs,;.'�' �< <? �Ss s'�:2%s:3, �.: ;r.22r1: SERVICES 101-0000-42403 0 $24.17, $0.00 "PAID 6Y� x 01W«. 01, �. ° M� RECE PTS#,:.ON HECK CLTD BYE <,. Ya, ..-„.. . .�� '�� 3 is DESCRIPTIONa q` AMOUNT �� AID PI�ID�DATE .�AM ., .� :ACCOUNT' s <,� SERVICES PC 101-0000=42600,:- 0 $12.09 $0.00 4 �} '9) 4Y _'.. •� .. ” t,.^ 'i' .:'T, ,�''?`1�. a 'PAID BYE '�YMETIOD RECEIPT# ,,' CHECK CLuTD BY Y. , Total Paid for ELECTRICAL:: $36.26 $6.00 v DESCRIPTIOfV ��, ACCOUNTS QTY AMOUNT PAID DATE,z _ v na .,hI, :9ry � °PAID 3. _ PERMIT ISSUANCE 101-0000-42404 - 0 $91.85 $0.00 s k AIDBY� :? � -MET O `RECEIPT#ewer �CLTDR x� . Total Paid for .PERM IT ISSUANCE: $91.85. $0.00 TOTALS:�� Description: ONEILL / ELECTRICAL PANEL CHANGE OUT FINANCIAL ADDITIONAL Type: ELECTRICAL Subtype: Status: APPROVED Applied: 12/16/2015 SGU Approved: 12/16/2015 SGU Parcel No: 646250002 Site Address: 49823 ADELITO DR LA QUINTA,CA 92253 Subdivision: TR 4275 Block: Lot: 2 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 ZIP PHONE FAX EMAIL Details: ELECTRICAL PANEL CHANGE OUT. 2013 CALIFORNIA BUILDING CODE MENDOZA ELECTRIC Printed: Wednesday, December 16, 2015 10:18:00 AM 1 of 2 �� „ FINANCIAL ADDITIONAL DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD CHRONOLOGY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 CONDITIONS Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 NAME TYPE NAME ADDRES51 CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT MENDOZA ELECTRIC 50-313 CALLE TOLOSA COACHELLA CA 92236 CONTRACTOR MENDOZA ELECTRIC 50-313 CALLE TOLOSA COACHELLA CA 92236 OWNER LOUIS BURR P O BOX 1901 LA QUINTA CA 92253 Printed: Wednesday, December 16, 2015 10:18:00 AM 1 of 2 �� „ FINANCIAL INFORMATION 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 $1.00 $0.00 BSA: Printed: Wednesday, December 16, 2015 10:18:00 AM 1 of 2 �� „ DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY 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:00 Printed: Wednesday, December 16, 2015 10:18:00 AM 2 of 2 grg7w_•------- Bin # ' .Cl ty of La Quin to Buifding 8t Safety Division Calle Tampico �� La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit 4i78-495 Tj�LL Project Address: q ._ Owner's Name: LJY 0 A,/ :e• A. P. Number: Address: 4ci _ s?_3 ASe- l 1--0 Legal Description: City, ST, Zip: LPr Qt l: �J A CA- 'q zzS3 Contractor:rn Z Q Telephone:hone: -'-l�O -b L� Address: I (� ` l Project Description: (GC�ri ccr,.rei City, ST, Zip: C012A Ck 2 ZQ Jb tJ O W Telephone: ne 0 �L P — — State Lic. # oLi S71 k City Lic. #.:010%316 Arch., Engr., Designer: Address: City, ST, Zip: ❑e: Telephone: a an cY• tr n e: Occupancy: Cons T uctto YP to Lic.# State L Project type (circle one • New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: QT %i�l�,� p Estimated Value of Project:L S_eDo • C7 d APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rcc'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"d Review, 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 HOUSE:- '"' Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees