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BELC2017-0010LICENSED 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: C10 License No.: 753548 v � Date:` 1-/ - % 177 Contractor: 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 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 wagesas 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: (760)360- Llc. No.: 7 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 th work for which this permit is issued. -X 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: PREFERRED EMPLOYERS INSURANCE COMPANY Policy Number: WKN149261 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 with those rovisions. Dater Z i / 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: Zh " Signature (Applicant or Agent): ' v `--- C 'VOICE (760) 777-7125 78-495 CALLE TAMPICO 0 D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN&•DEVELOPMENT DEPARTMENT . INSPECTIONS (760) 777-7153." BUILDING PERMIT Date: 2/7/2017 Application Number: BELC2017-0010 Owner: Property Address: 48103 CALLE SERANAS MICHAEL CHANEY . APN: 646110055 8900 SE REVENUE RD Application Description: CHANEY / CHANGE OUT PANEL BORING, OR 9 �-- � Property Zoning: Application Valuation: $2,500.00 z _ ci —r Co D Co Applicant: Contractor: m o RANGEL INC ES RANGEL INC 9 1255;D P 0 BOX 14427 P 0 BOX 144 " PALM DESERT, CA 92255 PALM DESER Iv C� 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: C10 License No.: 753548 v � Date:` 1-/ - % 177 Contractor: 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 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 wagesas 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: (760)360- Llc. No.: 7 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 th work for which this permit is issued. -X 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: PREFERRED EMPLOYERS INSURANCE COMPANY Policy Number: WKN149261 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 with those rovisions. Dater Z i / 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: Zh " Signature (Applicant or Agent): ' v `--- Date: 2/7/2017 Application -Number: BELC2017-0010 Owner: Property Address: 48103 CALLE SERANAS . MICHAEL CHANEY APN: 646110055 8900 SE REVENUE RD Application Description: CHANEY / CHANGE -OUT PANEL BORING, OR 92253 Property Zoning: Application Valuation: $2,500.00 Applicant' Contractor: . RANGEL INC RANGEL INC P 0 BOX 14427 P 0 BOX 14427 PALM DESERT, CA 92255 PALM DESERT, CA 92255 (760)360-7377 Llc. No.:.753548 . Detail: ELECTRICAL - CHANGE OUT (1)200 AMP ELECTRICAL PANEL. 2016 CALIFORNIA BUILDING CODE. DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0. $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC 101-0600-42600 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 Bin fl " City of La Q Llin to . t Building a Safety Division .Permit ,# 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Project Address: 03 G,- t % Sero- in Owner's Name: A. P. Nwnber:Address: Cq Legal Description: City, ST, Zip: L� Q v "� CA `7 02-S3 Contractor: e � G C eleh T onc.• G P -?�iGl .... Address: —7 3 t-( Calr�(C Dr , K Project Description: Z Oo %� 2&0A Cit ,_ Zi I — y'STP' � � � r -t �2 S C �"}- c is % Z Z / C ^ / 4P_ --V I Ge_` Telephone:/ l� G 737-7 5 State Lic. # : - /G %53S'�Fi City Lie. #: ®u l 0 2� Arch., Engr., Designer: Address: City, ST, Zip: Telephone: one: Contructi n s o Type: YP Occupancy: P cY State to Lic. # PrcPa (circle oAlter Re amr ty ne • N w Add'n Demo. Name of Contact Person: o,... �� + �. �.-.J Sq. Ft.: 1 , C2 ' %3 1 # Stories. #Units: Telephone # of Contact Person: 76 c, - 2,i - O `1 43 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd. TRACKING PERMIT FEES Plan Sets Plan•Chccksubmitted Item Amount Structural Calcs. Itevicwed, 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"' Review, ready for corrections/issue Electrical . Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 11.0:A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called ContacfPerson A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Pcrmit Fees