BELC2017-001278-495 CALLE TAM PICO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0012
Property Address: 52057 AVENIDA RUBIO
APN:. 773212024
Application Description: YOST / CHANGE OUT(1) 200 AMP PANEL'
Property Zoning:
Application Valuation:' $1,050.00
Applicant:
CISCO MARTINEZ ELECTRIC
43729 CAPE COD COURT
INDIO, CA 92201
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C10 License No.: 920201
Date" 2 — 10-1 -7
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, 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) 777-70.11
INSPECTIONS (760) 777-7153
Owner:
CYNTHIA HOLROYD
12503 NUTHATCH DR NW
GIG HARBOR, WA 92253
Contractor:
CISCO MARTINEZ ELECTRIC
43729 CAPE COD COURT
INDIO, CA 92201
(760)413-8714
Llc. No.: 920201
Dater 2/10/2017.
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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:
Carr' r: E MPT Polity Number:._
- LI, 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= /O — / �_ Applicant C
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. /
Date Signature (Applicant or Agent)"
. 1
Dater 2/10/2017
Application Number:
BELC2017-0012
Owner:
Property Address:
52057 AVENIDA RUBIO
CYNTHIA HOLROYD
APN:
773212024
12503 NUTHATCH DR NW
Application Description:
YOST / CHANGE OUT(1) 200 AMP PANEL
GIG HARBOR, WA 92253
Property Zoning:
Application Valuation:
$1,050.00
Applicant:
Contractor,
CISCO MARTINEZ ELECTRIC
CISCO MARTINEZ ELECTRIC
43729 CAPE COD COURT
43729 CAPE COD COURT
INDIO, CA 92201
INDIO, CA 92201
(760)413-8714
Llc., No.: 920201
Detail: ELECTRICAL - CHANGE OUT (1)200 AMP PANEL. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES
1010000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
0
$12.67
Total Paid for ELECTRICAL:. $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT. ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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Qin # City of La Quinta
Building 8£ Safety Division
Permit ## _ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
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Project Repair.air Demo
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Sq. Ft.:
# Stories:
# Units:
rTelephone # of Contact Person:24o 41 97/
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_Estimated Value of Project:/ago
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APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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°" Review, ready for corrections/issue
Electrical .
Subcontact'orList
Called ContactPcrson
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
1rd Review, ready for correct ionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees