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BELC2017-0054E'I 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BELC2017-0054• Property Address: 51655 AVENIDA VELASCO APN: 773133019 Application Description: BROWN/REPLACE ELECTRICAL MAIN PANEL 125AMP Property Zoning: Application Valuation: $2,400.00 Applicant: MENDOZA ELECTRIC 50-313 CALLE TOLOSA COACHELLA, CA 92236 JUN 1 2 2017 VOICE (760) 777-7125 FAX (760) 777-7011- INSPECTIONS 77-7011INSPECTIONS (760) 777-7153 Owner: RHONDA BROWN 51655 AVE NIDA VELASCO LA QUINTA, CA 92253 Contractor: MENDOZA ELECTRIC 50-313 CALLE TOLOSA COACHELLA, CA 92236 CITY OF LA QUINTA (760)404-7214 DESIGN AND DEVELOPMENT DEPARTMENTLIc. No.: 904511 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: C10 License No.: 904511 //Date: L Contractor. d ow0 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from'the tractor'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 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: Date: 6/12/2017 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 wfor which this permit is issued. -.-1 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: CITIZENS INSURANCE COMPANY OF AMERICA 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, l shall forthwith comply with those provisions. Date:- b 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 to enter upon the above- mentioned property for inspection purposes. Date: "o . /i 2,L12 Signature (Applicant'or Agent); '1 i Date: 6/12/2017 Application Number: BELC2017-0054 Owner: Property Address: 51655 AVE NIDA VELASCO -RHONDA BROWN APN: 773133019 51655 AVENIDA VELASCO Application Description: BROWN/REPLACE ELECTRICAL MAIN PANEL, 125AMP. LA QUINTA, CA 92253 Property Zoning: Application Valuation:, $2,400.00 Applicant: Contractor: MENDOZA ELECTRIC MENDOZA ELECTRIC 50-313 CALLE TOLOSA 50-313 CALLE TOLOSA COACH ELLA, CA 92236 COACH ELLA,. CA 92236 (760)404-7214 ------------=--------------`-------------------------=------------:-- Ll c. No.: 904511 Detail: 125A ELECTRICAL SERVICE CHANGE OUT [100A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA '. BUILDING CODES. i INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 10 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES 10170000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC' 101-0000-42600 0 $12.67 Total Paid for ELECTRICAL: $38.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5:00 Total Paid -for TECHNOLOGY ENHANCEMENT FEE: $5.00 t - Bin # v City 0f LQ Quinta Building 8t' Safety Division 78-495 Calle Tampico La Quinta, CA' 92253 - (760)' 777-7012. 00 Ll Building Permit Application and Tracking Sheet Permit # G U ( -7 Project Address: _ �r ✓ L Owner's Name: A. P. Number: Address: 0 Legal Description: I e c4" ca a."Je J. Contractor: or. nn7,7 �Jda LA �G / G City, ST, Zip: d u �� ('A Telephone: 32 3 3 Z a Address: -3a e.4 //E !o A S fi Project Description: Re- /a c � c /e c7'/i^, cq City, ST, Zip: : Oa►C%t t 9 ,22-,3 a . ,� „fie - �,,� ne• TeleP ho . i7 - D - / y y 72 - State Lic. # : Q s—/ City Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: :: Construction on T P e: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: C S T rnW pl L Sq. FL: # Stories: # Units: Telephone # of Contact Person: -7t, D - 4D't-(_ _U l �(. Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed 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 2ad Review; ready for corrections/issueElectrical 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 �� - �'�pw. `� �,_ .: