BELC2016-004078-495 CALLEtTAMPICO VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENTFAX (760) 777-7011
. INSPECTIONS.(760) 777-7153
BUILDING PERMIT
'Date: 4/13/2016
Application Number: BELC2016-0040 Owner:
Property Address: .78835 PARKBROOK CT Q JOSE GONZALES
APN:- 604411003 Q 78835 PARKBROOK
Application Description: GONZALEZ RESIDENCE / ELECTRICAL -L LA QUINTA, CA 92253
Property Zoning: A i JR 1
Application Valuation: $2,500.00 .2016
COMMUNi yI )E A 4U1NW Ti��
Applicant: QEyEtOPMENTDEPARTh}ENT MARK NELSON BUILDERS
MARK NELSON BUILDERS
13570 ST MARYS AVENUE . " 13570 ST MARYS AVENUE
RED BLUFF, CA 96080 RED BLUFF, CA 96080 .
(530)200-5581
Llc. No.: 815898 `
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: B. CIO,, CC -8, D49 License No.: 815898 /
`Date: �'' 7 " Contractor: /�/ �NV
: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 4
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.). .
(�_J I, asowner 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. 0 i . 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700iof 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 perfornance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy 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 :,s to become subject to the workers'
compensation laws of California, and agree thac, 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: K'j S- I G *pplicant: /,�1'^Cfjy
0
WARNING: FAILURE TO SECURE WORKERS' CON PENSATION COVERAGE 15 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 perform -2d under or pursuant to any permit
issued as a result of this application , the owne.�, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the --ity 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 cancelbtion.
I certify that I have read this application and stete 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 representa,ives of this city to enter upon the
above-mentioned property for -inspection purposes.
Date: ! ' (�. ' SigrWure (Applicant :)r Agent): Aae��
•
FINANCIAL •R •
4DESCRIPTION'& { ACCOUNT` QTY AMOUNT -e' # } 4P..AID'PA DATE
,
ew' a
BSAS SB1473 FEE
101-0000-20306 0 $1.00 $1.00'
4/13/16
PAID,BYEx ^
S ° METHOD .wM%RECEIPT # rx mCHECK #-�{
CLTD BYE
,`.
ONE TIME
CHECK R14698 6186
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
, 4 DESCRIPTION �
ACCO(1NT €
QTY
*AMOUNT
! PAIDx
PAID: DATE
;y x
SERVICES
101-0000-42403
0
$24.17
$24.17
4/13/16
4� f � � ,.., tip, :• J
PAIDtY
: 4 .. b,.P' } yid..
METHODS r
k'.� 1e�syl �Y 1
RECEIPT #+ �
� i!Y� •, h .: �,�
CHECK #
� CLTD BYt;
a w
ONE TIME
CHECK
R14698
6186
MFA
` 'F DESCRIPTION
' t'ACCOUNT= 2.
QTY
AMOUNTr.
� PAID 6F;
PAID DATE:,
.° n
SERVICES PC
101-0000-42600
0
$12.09
$12.09 1
4/13/16
',METHOD --`s
5`CLTD BY
�sPAID-'BY_ y
,F
RRECEIPT
ONETIME
CHECK
R14698
6186
MFA,
Total Paid for ELECTRICAL: $36.26 $36.26
DESCRIPTION " '
�CNV* Q
COU
<Q "t
TY
AMOUNT
, a 3 ;
PAIDb,
PAID DATE
�w
.
PERMIT ISSUANCE
101-0000-42404
0.
$91.85
$91.85
4/13/16
¢" PAID BY M� '
#METFIOD �'
#1 3
CHECK # x
CLTD BY
a
u11
��RECEIPT
ONE TIME
CHECK
R14698
6186
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
Description: GONZALEZ RESIDENCE /'ELECTRICAL
Type: ELECTRICAL Subtype: Status: ISSUED
Applied: 4/13/2016 MFA
Approved: 4/13/2016 MFA
Parcel No: 604411003 Site Address: 78835 PARKBROOK CT LA QUINTA,CA 92253
Subdivision: TR 23995-4 Block: Lot: 3
Issued: 4/13/2016 MFA
Lot Scl Ft: 0 Building Scl Ft: 0. Zoning:
Finaled:
Valuation: $2,500.00 Occupancy Type: Construction Type:
Expired: 10/10/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ADDRESS1'
Details: ELECTRICAL SERVICE UPGRADE 100 AMP TO 200 AMP PER 2013 CALIFORNIA BUILDING CODE
Applied to Approved
j 'Approved to Issued
FINANCIAL INFORMATION
Printed: Wednesday, April 13, 2016 10:49:21 AM 1 of 2'
SYSTEMS
STATE
ZIP, :'
PHONE _ -
FAX EMAIL
;NAME TYPE
NAME
ADDRESS1'
CONTACTS
CITY ". "'
APPLICANT
MARK NELSON BUILDERS
13570 ST MARYS
AVENUE
RED BLUFF
CA
96080
BONNIENELSON6@GM
AIL.COM
CONTRACTOR
OWNER
MARK NELSON BUILDERS
JOSE GONZALE "
S �
13570 ST MARYS
AVENUE
RED BLUFF
CA
96080
BONNIENELSON6@GM
AIL.CQM
78835 PARKBROOK
LA QUINTA
CA
92253
FINANCIAL INFORMATION
Printed: Wednesday, April 13, 2016 10:49:21 AM 1 of 2'
SYSTEMS
--7 -- -�
-
-.- ._,--- -
_ - ,
v:
_ -
_ _ �, _�
_.
CLTD
DESCRIPTION.
ACCOUNT,, -:,
QTY:
;AMOUNT
PAID;,
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
4/13/16
R14698
6186
CHECK
ONE TIME
MFA
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:'
SERVICES
101-0000-42403
0
$24.17
$24.17
4/13/16
R14698
6186
CHECK
ONE TIME
MFA
SERVICES PC
101-0000-42600
0
$12.09
$12.09
4/13/16
R14698
6186
CHECK
ONE TIME
MFA
Total Paid for ELECTRICAL: $36.26 $36.26
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
4/13/16
R14698
6186
CHECK
ONE TIME
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
,....,,,..:INSPECTIONS.
.,,;,,:, PARENT PROJECTS ... .
Printed: Wednesday, April 13, 2016 10:49:21 AM 2 of 2
SYSTrms
Bin #
City of La Quin to
Building 81• Safety Division
V 78-495 Calle Tampico
D(�La Quinta, CA 92,253 - (760) 777-7012
Building Permit Application and Tracking Shut
Permit #�
Project Address:
Qwner's Name:cpsi .e . p on
A. P. Number:
Address:i rr
Legal Description:
City, ST, Zip:
c, cio 92,253
Contractor:
1_
/ e
e
Telephone:
e!hne• o
Address:. 1 5 b
Project Description:
G v� C -
City, ST, Zip:e w C
ne•
TeleP ho .
00 -iti P
State Lic. # : )Clk
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
P y:
State Lie. #:
Project type �circle one • New Add'n Alter Repair Demo
Name of Contact Person: i �' G G
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person: 1-1 3 ci 3 Z
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Recd
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"" Revic\v, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN`HOUSE:-
'q Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
i
Total Permit Fees