BELC2015-0028tv,'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CAROLYN W UHL
51145 CALLE QUITO
LA QUINTA, CA 92253
]IMMUNITY DEVELOPMENT DEPARTMENT
BELC2015=0028
51145 CALLE QUITO
770143012
UHL/MAIN ELECTRICAL SWITCH
$300.00
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
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.: 968972
Date -' S
OWNER -BUILDER DECLARATION
,5idy%03- 9iE-i7e
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Stater
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any 1
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 contractors) licensed pursuant to
the Contractors' State License Law.).
I. _J 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATI.7N 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 thork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Secfion 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:
Carri Policy Number:
I certify that in the performance of the work for which this permit is issued, I
shal 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 37`-70 of the Labor Code, I shall forthwith
comply with those provisions.
Date' —7 i� �S Applicant: bIG4C Sia 466 aw _MIU&Ll
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 ?N 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 applica_ion becomes null and void if work is
not commenced within 180 days from date of isouance of such permit, or cessation of
work for 180 days will subject permit to cancellation. f .
I certify that I have read this application and sta-,e 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 representatves of this city to enter upon the above-
mentioned property for inspection purposes.
q �t� /S Signature (Applicant or Agent)! Te5p 1165
�^d
Date: 4/16/2015
Owner:
MOE ROSEMARY LIVING TRUST
z
R 0 BOX 1356
LA QUINTA, CA 92253
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Contractor:
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DESERT SANDS ELECTRICAL
CIA–
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83-614 MECCA HILLS AVENUE
COACHELLA, CA 92236
0
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(760)601-80.70
i�
Llc. No.: 968972
WORKER'S COMPENSATI.7N 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 thork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Secfion 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:
Carri Policy Number:
I certify that in the performance of the work for which this permit is issued, I
shal 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 37`-70 of the Labor Code, I shall forthwith
comply with those provisions.
Date' —7 i� �S Applicant: bIG4C Sia 466 aw _MIU&Ll
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 ?N 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 applica_ion becomes null and void if work is
not commenced within 180 days from date of isouance of such permit, or cessation of
work for 180 days will subject permit to cancellation. f .
I certify that I have read this application and sta-,e 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 representatves of this city to enter upon the above-
mentioned property for inspection purposes.
q �t� /S Signature (Applicant or Agent)! Te5p 1165
�^d
Fl NANCIAL INFORMATION:
r • DESCRIPTION;"*- , ,` ACCOUNT
QTY °
` AMOUNT 3 PAID - PAID`DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $0.00
f PAID,BY •` t ` •`"i -,METHOD:,
RECEIPT # s CHECK #� !: CITD BY .
Total'Paid forBUILDING STANDARDS'ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION= , r " , . ,
- ��ACCOUNT dy '
:
QTY
' AMOUNTS ,
`' PAID
w �_ � e�
,PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY ;
METHOD aid r
f 'RECEIPT #,
�t' `CHECK # ,'`Y
a ,CLTD BY
ACCOUNT F-.,
QTY'
AMOUNT . "•
..xt . PAID ;" * a
PAID DATE.
DEVICES, FIRST 20 PC
101-0000-02600
0
$24.17
$0.00
PAID BY'` R
, , METHOD R
°' 4,RECEIPT #
`CHECK # i'
CLTD BY
Total Paid for ELECTRICAL: $48.34 $0.00
'' Fa .DESCRIPTION ", _• -a R _
y q
%_ e ` ACCOUNT Er
QTY`
AMOUNT`}
PAID,' ,3
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.60
'PAID BY ar
;METHOD T �<
RECEIPT #
Total Paid for PERMIT ISSUANCE: $91.85
1
,
s; ��CHECK-#A'
$0.00 -
j
Description: UHL/MAIN ELECTRICAL SWITCH
Type: ELECTRICAL Subtype:
Status: UNDER REVIEW
Applied: 4/16/2015 SKH
Approved:
Parcel No: 770143012 Site Address: 51145 CALLE QUITO LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 5 Block:
Lot: 112
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $300.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: ELECTRICAL - REPLACE (1) MAIN SWITCH IN ELECTRICAL PANEL. 2013 CALIFORNIA BUILDING CODES:
�.
CONDITIONS
Printed: Thursday, April 16, 2015 4:23:50 PM 1 of 2 ° SYSTEMS
_ .... _ ...... . ... ... ... .
PARENT PROJECTS -
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, April 16, 2015 4:23:50 PM 2 of 2
CRFWIYST*8A4S
Bin #
.0ty of La Qu(nta
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: qr ml�4 L rT0
Owner's Name: t,A.
P. Number:
Address: �/ — / �� h. c ! o
Legal Description:
Contractor:Te
City, ST, Zi u
le hone: —O
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Address: FM )weepe,
Project Description:
City, ST, Zip: (
' [ 'LCA
Telephone:
___
State Lic.
City Lica
Arch., Engr., Designer:
Address:
City., ST, Zip:
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P » >;<>»»_
Telephone:
State Lic. #:
Co nstructi n Type: e:
Occupancy: Y
P PancY: Q hl
Project e (circle ole one : New Add'n t
h'P �c�t �1 er Repair Demo
J w
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
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 Cales.
.Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Bala ace
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Zed 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 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
Atl