BELC2015-002278-495 CALLE TAMPICO D 4v VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/24/2015
Application Number: BELC2015-0022 Owner:
Property Address: 49295 AVENIDA FERNANDO CHARLES FAUSEL
APN: 658280009 P 0 BOX 920
Application Description: FAUSEL RICHARD PANEL`CHANGE OUT LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,800.00
Applicant:
BRADLEY ELECTRIC INC.
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
'p Q D .
nR 2 4 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Incensed under provisions o Chapte
9 (commencing with Section 7000) of Division 3 of th Business and Professi ns Code,
and my License is in full force and effect.
License Cress: License No.: :LIC -000295
ate: Contractor•
OWNER -BUIL DE ECLARA_TI.ON
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 Divisi
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 fo a
permit subjects the applicant to a civil penalty of not more than five hundred dollait
($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.).
( ) 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
Lender's
Contractor:
BRADLEY ELECTRIC INC.
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
(760)360-0940
Llc. No.: :LIC -0002958
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:
Carrier: _ Policy Number:
1 certify that in the performance of the wor for which t �permit is issued,
shall not employ any person in any manner so as to b ome subject td t workers'
compensation laws of California, an agree that, if I sh Id become subJ ct to the
workers' compensation provisions of Se on 3700 of the bor Code, I s I .with
comply with thgseprovisions. _ \�*
WARNING: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPL YER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLAR-S-($=,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 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 � ove information' correct.
I agree to comply with all city and county ordinances a aws re ' to uilding
construction, and hereby authorize representative is city enter upon th bove-
,mentiongd propdity for inspection purposes.
Signature
DESCRIPTION .
ACCOUNT QTY AMOUNT PAID: PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
PAID BY METHOD, RECEIPT # CHECK # CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA:
I$1.00
$0.00 '
DESCRIPTION
ACCOUNT; -:QTY
PAID
AMOUNT ;
PAID
PAID DATE
0
1$12.09
$0.00
PAID BY
SERVICES
101-0000-42403
0
1$24.17
$0.00
PAID BY , .:.
METHOD
'RECEIPT #
CHECK'#
CLTD BY
.DESCRIPTION ..
;ACCOUNT
$0.00
QTY
;; AMOUNT
PAID
PAID DATE
SERVICES PC
101-0000-42403
0
1$12.09
$0.00
PAID BY
METHOD
101-0000-42404
RECEIPT #.
CHECK #
CLTD BY
Total Paid for ELECTRICAL:
I $36.26
$0.00
DESCRIPTION
ACCOUNT
QTY,,
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
I $91.85
$0.00
PAID BY
METHOD ;, ::
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: 1 $91.85 $0.00
Description: FAUSEL RICHARD PANEL CHANGE OUT
ADDITIONAL
CHRONOLOGY
Type: ELECTRICAL Subtype:
Status: UNDER REVIEW
Applied: 3/24/2015 PJU
Approved:
Parcel No: 658280009 Site Address: 49295 AVENIDA FERNANDO LA QUINTA,CA 92253
Subdivision: LA QUINTA GOLF ESTATES 1 Block:
Lot: 142
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $1,800.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
APPLICANT
Details: REPLACE DAMAGED ELECTRICAL PANEL CHANGE OUT 200 AMP SAME FOR SAME. 2013 CALIFORNIA ELECTRICAL CODES.
Printed: Tuesday, March 24, 2015 10:36:50 AM 1 of 2
SYSTEMS
ADDITIONAL
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP + PHONE .'FAX' EMAIL
APPLICANT
BRADLEY ELECTRIC INC.
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
CONTRACTOR
BRADLEY ELECTRIC INC.
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
OWNER
CHARLES FAUSEL
P 0 BOX 920
LA QUINTA
CA
92253
Printed: Tuesday, March 24, 2015 10:36:50 AM 1 of 2
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
.
PAID BY
CUD
BY
SERVICES
101-0000-42403
0
$24.17
$0.00
SERVICES PC
101-0000-42403
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:$0.00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
ELECTRICAL FINAL" BLD.
PARENT PROJECTS
BOND INFORMATION
Printed: Tuesday, March 24, 2015 10:36:50 AM 2 of 2
SYSTEMS
Bin f{ Qty of La Qui to.
Buifding 8F Safety Division
Permit j P.O. Box 1504, 78-495.Calle Tampico .
l La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and ��Tracking- Sheet
Project Address . �-� Owner's Name,: ,1Ct CH jg F7A U E;(___
A. P. Number:
Address: A
veI
Legal Description:
City, *ST, Zip: � 't d�
Telephone
P
Contractor:
AT)CYT�I�*��
(,. '�
Address: s -f "
Project Description: _
City, ST, Zip:
' A..............
Tele hone: :.:s;
P rl� d
r
5 Iq City Lia #t
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:•>- > : »:>< :> >:>
Construction Type: Occupancy:
State Lic. #::.
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person-.
Sq. Ft.:
# Stories:
# Units:
Telephone, # of Contact Person:
O
Estimated Value of Projcc : 0•
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Rcq'd Recd TRACKING PERMIT FEES
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Planspicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2ed Review, ready for corrcclions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
7rd Review, ready for correct ionslissuc
Developer Impact Fee
Planning Approval
Called Contact.Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School rocs
Total Permit Pccs
C. a ��29L