BELC2015-0063. 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.
Liceennnsse.Cl5s�s:�C10 License No.: 90511522 -
Dat" e� 1 Contractor."' U V f'Sy
OWN ER -BU I LDER.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.).
(� 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 whobuilds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I Lam 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:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of -perjury onelof 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 th -Mor which this permit is'issued.
ne I have and wilfmaintain 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' Policy.Number:
I certify that in the performance of the work for which this permit is issued, I
,61•not-emploq,gy 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, l shall forthwith
comply.with hoseii.provisions. L1 /
Date, 0' x!4S ApplicAt�� 0
WARNING: FAILURE TO SECURE'WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND,SHALL SUBJECTAN EMPLOYER -TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION;.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby:ina.de to the Building Official for a permit subject to
the'conditions and restrictions set forth,on this application. .
1. Each person upon:whose behalf this application is made; each person at whose
'request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall. defend;,indemnify and hold har'mless the City of La Quinta, its officers, agents; and
employees for -any ac t or omission related to the -work being performed under or
following issuance of this permit:
2, Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have -read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws r latingto building
con struction,'and hereby'authorize representatives of this city to a upon b0e
mentionedproperty'for inspection purposes.
�te:'� • V '� Signature (Applicant or Agent):
VOICE (760) 777-7125
7$-495'CALLE TAMPICO
FAX, (760) 777-7011
LA QUINTA, CALIFORNIA 92253
•
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING -PERMIT
Date: 8/17/2015
Application Number:
BELC2015-0063
4
Owner:
Property Address:
78860 SANITA•DR
MICHAEL -COOK
APN:
604163011,
78860.SANITA DR
Application Description:
COOK / CHANGE OUT 200 AMP ELECTRICAL PANEL
LA QUINTA, CA,92253
Property Zoning:
Application.Valuation:
$1,100.00
Z D
cD
Applicant:
Contractor:
m o �.
PROGRESSO ELECTRIC
PROGRESSO ELECTRIC
79140 KAYE COURT
79140 KAYE'COURT.
"' ry
LA QUINTA, CA 92253
LA QUINTA, Ck92253
0 � o_
v
a Cil
9
(760)343-8952
m
Llc. No.: 905152
. 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.
Liceennnsse.Cl5s�s:�C10 License No.: 90511522 -
Dat" e� 1 Contractor."' U V f'Sy
OWN ER -BU I LDER.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.).
(� 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 whobuilds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( I Lam 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:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of -perjury onelof 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 th -Mor which this permit is'issued.
ne I have and wilfmaintain 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' Policy.Number:
I certify that in the performance of the work for which this permit is issued, I
,61•not-emploq,gy 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, l shall forthwith
comply.with hoseii.provisions. L1 /
Date, 0' x!4S ApplicAt�� 0
WARNING: FAILURE TO SECURE'WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND,SHALL SUBJECTAN 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:ina.de 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 har'mless the City of La Quinta, its officers, agents; and
employees for -any ac t 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 r latingto building
con struction,'and hereby'authorize representatives of this city to a upon b0e
mentionedproperty'for inspection purposes.
�te:'� • V '� Signature (Applicant or Agent):
®'
x DESCRIPTION :;"
COUP QT
X r y .' O ,�
WP AIDDATE
a< a.� �.
, ;%. ,� ��,.•,.r,r,,u, a. ::sr:..<
�AM�N� ��PAID
e., �irP, n
BSAS SB1473 FEE 101:40000,110306
1 00r00a.0
S I'rETr°.''i.�•8M�"�i
'A'yC.I":D'. w BY�SvF.,:i_. ''is'G. '.' C. '�m`FY'£
HOD( RUINS
}
2&+
5B A•c
mn CL' 4T'•
	T 1111,
waIkVz`
�l-H WON #
•TotalPaid for BUILDINGSTANDARDS ADMINISTRATION BSAc $1 00 $0.00
.:
WNW '� �,'� '�
DESCRIPTIONS �g
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_; ACCOUNT �
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- �isi�'`"',,�"!�..d:'
�aPAID
E
�'PAID�DATU
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SERVICES
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,PAID �.I��.PAIDDATE;
SERVICES PC
101 0000-42403 ars$
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$12.09
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s.R-!.jz`S ..S' .@',3 �,X"'i'£KN�yf
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TotahPAidf6rELECTRICAL $36.26. $0.00
3-M;,'S_y�
DESCRIPTION �
QTY
AMOUNT
r� : �PA'ID� :+
PAIDtDATEl
y
.-w`�§.:% e,`6 n"`x
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PERMITISSUANCE
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Y ) $Y;. �`S° h i':4...�: °;^{ i2i�`He3 "`L. - :s3 ' "S` a'SY }i fi...
`.F x""4'3 ,. ire Ni p � �g "N"'' S 11419 1. � yi C{il }�GE. i k�f',� i
�� PAID B
,r••.. £Y �et..,,�.. .E; > ., Yr}cF S,. }�4{C4. !iqS ay'Fi ,. ::
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METHOD
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Total Paid for PERMITISS�l1ANCE $0.00
r.F
Description: COOK] CHANGE OUT 200 AMP 'ELECTRICAL PANEL
Type: ELECTRICAL
Subtype:
Status: UNDER REVIEW
Applied: 8/17/2015 SKH
Approved:
Parcel No: 604163011 Site Address: 78860 SANITA DR LA QUINTA,CA 92253
Subdivision: TR 23269
Block:
Lot: 111
Issued:
Lot Sq Ft: 0
Building Sq Ft:*O
Zoning:
Finaled: .
Valuation: $1,100.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: ELECTRICAL - CHANGE OUT (1) LIKE FOR LIKE 200 AMP ELECTRICAL PANEL. 2013 CALIFORNIA BUILDING CODES.
CONDITIONS
Printed:. Monday, August 17, 2015 11:18:14 AM 1 of 2 AMAMMEAF
SYSTEMS
Printed: Monday, August 17, 2015 11:18:14 AM 2 of 2 f�;,
SYSTEtitS
f.
.
"Bin #
3
Qty df La, Quin.t'a
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253- (760) 7777012.
Building Permit Application and Tracking Sheet
Permit #
�"� 5�-
Project Address:— � In` "'_ cir '
Ownei•'i Name: C � �1 1.
A. P. Number:
Address:
Legal Description:
City, ST, Zip://^ `
lA 11/� `t
f _�
-77
7 � z Y-?
Contractor: Vo Y >✓ S
�
Telephone: hone:
Address: !}� o
Project Description:
City, ST, Zip: CJi i�.
1 C-
,E✓
ne•
TeleP ho . Q.
�y7
1 � � a d
State Lic. # : 4701jj
s
Cit y Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Tele hone:
.
......
oft:s
tructi -
on,TYPe• Occupancy-
aneY
State Lic. #:
Proe t type (circle one • New A d'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
T# Units:
Telephone # of Contact Person:
Estimated Value ofProi ectA. I l C
APPLICANT: DO. NOT;WRITE BELO.W,THIS LINE.. .....
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit.
Truss CAcs.
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
'Plans picked up
S.M.L
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 ofpermit issue
School Fees
Total Term it -Fees
60