BELC2017-001378-495 CALLE TAMPICO a U -` QU&20-
LA
QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
VOICE (760) 777-7125
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Owner:
KSL DESERT RESORT
1 POST OFFICE SQ STE 3100
BOSTON, MA 0
Applicant:
BUILDING PERMIT
RON MARTINEZ ELECTRIC'
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Application Number:
BELC2017-0013
Property. Address:
78550 AVENIDA ULTIMO
APN:
770040010
Application Description:
LA QUINTA'DUNES RESORT / 200 AMP PEDISTAL
Property Zoning:
Llc. No.: 510541 t,
Application Valuation:
$2,500.00
VOICE (760) 777-7125
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Owner:
KSL DESERT RESORT
1 POST OFFICE SQ STE 3100
BOSTON, MA 0
Applicant:
Contractor:
RON MARTINEZ ELECTRIC'
RON MARTINEZ ELECTRIC
38-455 BEL AIR
38-455 BEL AIR
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CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
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(760)333-0974
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Llc. No.: 510541 t,
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: C1,0C ^License No.: 510541
Date: 2—�J —�'/ k'Contractor:
OWNER -B DER 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).;
(_) 1, 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 Na
Lender's
Date:' 2/15/2017
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 work for which this permit is issued.
it 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 polity number are:
Carrier: EXEMPT Policy Number: _
K RI 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 s become subject to the -
workers' compensation provisions c Section 370 of a Labor de, I shall forthwith
comply with those provisions.
Date: —IJ --I? App' cant:
WARNING: FAILURE TO SECURE WO RS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER O 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 build'
construction, and hereby authorize representatives of this city to en u on the
above-mentioned property for inspection purposes. /
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Date: ��J Signature (Applicant or Agent)
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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.
it 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 polity number are:
Carrier: EXEMPT Policy Number: _
K RI 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 s become subject to the -
workers' compensation provisions c Section 370 of a Labor de, I shall forthwith
comply with those provisions.
Date: —IJ --I? App' cant:
WARNING: FAILURE TO SECURE WO RS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER O 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 build'
construction, and hereby authorize representatives of this city to en u on the
above-mentioned property for inspection purposes. /
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Date: ��J Signature (Applicant or Agent)
Date: 2/15/2017
Application Number: ...-BELC2017-0013
Owner:
Property Address: 78550 AVENIDA ULTIMO
KSL DESERT RESORT
APN: 770040010
1 POST OFFICE SQ STE 3100
Application Description: LA QUINTA DUNES RESORT / 200 AMP PEDISTAL
BOSTON, MA 0
Property Zoning:
Application Valuation: $2,500.00
Applicant:
Contractor:
RON MARTINEZ ELECTRIC
RON MARTINEZ ELECTRIC
38-455 BEL AIR
38-455 BEL AIR
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
(760)333-0974
---------------------------------------------------------------------------------
Llc. No.: 510541
-------------
Detail: ELECTRICAL / 200 AMP COMMERCIAL PEDISTAL CHANGEOUT. PER 2016 CBC.*
FINANCIAL INFORMATION
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
POWER APPARATUS
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
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
Bin #City
Permit #;
Project Address:
of La Quin to
Building 8£ Safety Division
. . 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name:
A. P. Number:
Address:
Legal Description: S—
vt"
City, ST, Zip:
Contractor: D
Tele h ne:
Address: c1 60— 7 r
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Project Description:
City,ST, Zi
t
Telephone: 3 --o
3
rQ�L,
State Lie. # :
City Lie.
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Occupancy:
Construction TY Pe: ancY:
State Lie. #.
tYP Demo (circle one): New Add'n Alter Repair
Name of Contact Person: ���/GC�
Sq. Ft.:
# Stories:
#Units:
Telephone #. of Contact Person:
t! o— ^ 0/2
Estimated Value of Project: S OQ
APPLICANT: DO. NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rce'd
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.
Tit!e 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
2" Review, ready for'eorreclions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing ,
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks- Appr
Date of permit issue
Schon! Fees,
Total Permit Fees
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