BELC2016-006278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BELC2016-0062
Property Address: 81830TIBURON DR ,
APN: 767580018
Application Description: PGA WEST / 200A METER
Property Zoning:
Application Valuation: $2,000.00
Applicant:
RON MARTINEZ ELECTRIC
38-455 BEL AIR
CATHEDRAL CITY, CA 92234
D XP VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY. DEVELOPMENT DEPARTMENT , INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/13/2016
Owner:
LQR GOLF
JUL 12 2015 1 BUSH ST STE 1100
'EDEST L CIA_NGEOUT SAN FRANCISCO, CA 0
CITYOFLAQUJNl
COMMUNITY OBlc'! ORkiENTDEP,+RT?,LENT
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: C30 License No.: 510541
Date: 7 ��` Contractor:
OWNER -BUIL 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 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 contractors) 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
Contractor:
RON MARTINEZ ELECTRIC
38-455 BEL AIR
CATHEDRAL CITY, CA 92234
(760)333-0974
Llc. No.: 510541
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:
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 subjecl to the
workers' compensation provisions of Section 3700 of the L ode, I all forthwith
comply with those provisions.
Date: 7%l'Applicant:
WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRI INAL 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 ente n the
above-mentioned property for inspection purposes. l -
Date: �7 1�%6 Signature (Applicant or Agent):
G
FI NANciAL 'INFORMATION.
�DESCRIPTIOW4 ACCOUNT �� # �QTY� �`. AMOUNT- �' � PAID PAIDZATE,
BSAS SB1473 FEE ' 101-0000-20306
0, $1.00
$0.00
-,° N.k u A",METHODx-s a
RECEIPT #i
411rPAIDBY
° CHECK # CLTD BY'
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPT!ON ,s
}' .- ACCOUNT '
:QTY
AMOUNT,',`. }�
t ' >i PAID '` ?
PAID'DATE
SERVICES
101-0000-42403
0
$24.17
$0.00
` ;Pi416BY `'�
� METHOD w s
.x' 'RECEIPT # � �
#: CHECK # r
CLTD BY,
DESCRIPTION =A
€�" X
ACCOUNT
2.� Q�: 3.. 3
QTY$
k.:.
'J i4MOUNT ° w
'3 .✓ rd".,.
``PAID x
e.a.'�^i
PAIU`DATE .
k .a^Nix
SERVICES PC
101-0000-42600
0
$12.09
$0.00
.PAID BY'METHODk
r `
'RECEIPT
CLTD BY
Total Paid for ELECTRICAL: $36.26 $0.00
DESCRIPTION r
ACC .
OUNT
QTY.
AMOUNT
aPAID
PAID'DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85,
$0.00
PAID BY
a METHODS 'z `
! 3 VRECEIPT # &
' CHECK
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0t
Description: PGA WEST / 200A METER PEDESTAL CHANGEOUT
Type: ELECTRICAL '
Subtype: Status: APPROVED
Applied: 7/13/2016 MFA
Approved: 7/13/2016 MFA
Parcel No: 767580018. Site.Address: 81830 TIBURON DR LA QUINTA,CA 92253
Subdivision:
Block: Lot: 41
Issued:
Lot Scl Ft: 0,
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $2,000.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: 200 AMP PEDESTAL CHANGE OUT DUE TO GOLF CART CRASHING INTO IT. PER 2013 CALIFORNIA BUILDING CODE
Printed: Wednesday, July 13, 2016 9:38:33 AM 1 of 2
SYS7C•tiiS'
DESCRIPTION
ACCOUNT
QTY
- -
AMOUNT
PAID
PAID DATE
-
yyRECEIPT #
-- -
CHECK #
-- -
METHOD
-
- PAID BY
CLTD
•BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
SERVICES
101-0000-42403
0
$24.17
$0.00
SERVICES PC
101-0000-42600
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
60
......... ...... .... INSPECTIONS
lIRENT PROJECTS .
ATTACHMENTS
Printed: Wednesday, July 13, 2016 9:38:33 AM 2 of 2 „,
SYS'lfiMS'
Bin #
04ty of La Quin to
Building & Safety Division
7&495 Calle Tampico
' La Quinta, CA 92253 - (760) 77747012
Building Permit Application and Tracking Sheet
Permit #7&495
a"
Project Address: V —)930
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: r V .
Telephone:. .
ele P
Address:(30_ �� 2
Project Description:
1D 2 Si4
City, ST, Zip:
Telephone:
J ..............
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L La -1 f
State Lie. # : S d City Lie. #.-
'—
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
on tr t•
C s uc ton Type: Occupancy:
P
t to Lic. #:
Sa
Project type e
circle one • New e Add'n Alter J
()• A r ReA ai r Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone•# of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
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.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jrd Review, ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
t
A AS I A-11" 4 q
INK f CV , 0
'FIT
............
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