BELC2015-003378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
•
Application Num er: BELC2015-0033
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address: 54200 AVENIDA JUAREZ
APN: - 774194010
Application Description: FANNY MAE HOME/ELECTRICAL
Property Zoning:
Application Valuation: $100.00
Applicant:
SMITH & SONS CONSTRUCTION INC.
9416 WILSON RANCH ROAD
PHELAN,CA 92371
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: License No.- 810322 /,
Date:, -5--1 t "1"s Contractor:J54
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
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).:
(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 Name
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
REID EYLER
54200 AVENIDA JUAREZ
LA QUINTA, CA 92253
Contractor:
SMITH & SONS CONSTRUCTION
9416 WILSON RANCH ROAD
PHELAN, CA 92371
(909)885-2220
Llc. No.: 810322
Date: 5/11/2015
. WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of.perju y 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
offor which this permit is issued..
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: _ Polity 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 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 withthoseprovisions.
Date: �'�t IS Applicant:
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 enter upon the a ove-
mentioned property for inspection purposes. 11
A&//2'5
Date: -5 ( Signature (Applicant or Agent):'
DESCRIPTION ,.
FINANCIAL INFORMATION
ACCOUNTQTY
AMOUNT
PAID PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY ;
METHOD
' RECEIPT:#
CHECK # CLTD BY
Total Paid for BUILDING'STANDARDS ADMINISTRATION'BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT .
PAID
PAID DATE
SERVICES
101-0000-42403
0
$24.17
$0.00
PAID, BY
r METHOD
RECEIPT #
CHECK #, "
CLTD BY.
DESCRIPTION '. ". f
ACCOUNT
QTY.
'AMOUNT',
PAID
PAID -DATE
SERVICES PC
101-0000-42403
0
$12.09
$0.00
PAID. BY .'
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $36.26 $0.00
DESCRIPTION -
ACCOUNT
QTY
AMOUNT
PAID.
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS: $129.11 00
Description: FANNY MAE HOME/ELECTRICAL
Type: ELECTRICAL Subtype:
Status: APPROVED
Applied: 4/30/2015 MFA
Approved: 5/5/2015 MFA.
Parcel No: 774194010 Site Address: 54200 AVENIDA JUAREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 256
Lot: 15
Issued:
UNIT 24
NAME
'ADDRESSI' -
Lot Scl Ft: 0 Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $100.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 . No. Stories: 0
No. Unites: 0
9416 WILSON RANCH
ROAD
Details: ELECTRICAL- REPLACE MAIN BREAKER 200 AMP SINGLE HANDLE. 2033 CALIFORNIA BUILDING CODE.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
'ADDRESSI' -
CITY'
STATE
ZIP
.'PHONE
FAX.,
EMAIL
APPLICANT
SMITH & SONS CONSTRUCTION INC.
9416 WILSON RANCH
ROAD
PHELAN
CA
92371
(
CONTRACTOR
SMITH & SONS CONSTRUCTION INC.
9416 WILSON RANCH
ROAD
PHELAN
CA
92371
(
OWNER
REID EYLER
54200 AVENIDA JUAREZ
•LA QUINTA
CA
92253
(
FINANCIAL INFORMATION '
Printed: Monday, May 11, 2015 9:05:16 AM 1 of 2
SYSTEMS
DESCRIPTION
AC COUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHE CK'#
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
SERVICES
1010000-42403
.0
$24.17
$0.00
SERVICES PC
101-0000-42403
0
$12.09
$0.00
Total Paid forELECTRICAL: $36.26 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.8s $0.00
TOTALS: $129.11 $0.00
INSPECTIONS
DATE DATE
ELECTRICAL FINAL" BLD
PARENT PROJECTS
� Minted: Monday, May 11,ZOl69:05:l6AK4 2of2 CRWYSTEMS