BELC2014-1039Applicant:
MOX ELECTRIC
54225 AVENIDA MENDOZA
LA QUINTA, CA 92253
OCT 2 2 2014
CITY
COMMUNITY OE
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.::LIC-0107359
Dater rZ Zy 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 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 witha contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� I am exempt under Sec. B.&P.C. for this reason
Date. C/142— Z �Owner: "6 c t4t:� si
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:
Contractor:
MOX ELECTRIC
54225 AVENIDA MENDOZA
LA QUINTA, CA 92253
(760)567-3660
Llc. No.: :LIC -0107359
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 subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date'ZZ %L Applicant: Z ,_
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS - NLAWFUL,
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.
LQegify 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: ZZ /
' Signature (Applicant or Agent)/
I �
- NtII��I/
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D ` f
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/22/2014
Application Number:
BELC2014-1039
Owner:
Property Address:
53330 AVENIDA VALLEJO
KRAMER RESIDENCE
APN:
774083005
53330 AVENIDA VALLEJO
Application Description:
PANEL CHANGE OUT 125 TO 200 AMP
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,127.00
Applicant:
MOX ELECTRIC
54225 AVENIDA MENDOZA
LA QUINTA, CA 92253
OCT 2 2 2014
CITY
COMMUNITY OE
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.::LIC-0107359
Dater rZ Zy 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 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 witha contractor(s) licensed pursuant to
the Contractors' State License Law.).
(� I am exempt under Sec. B.&P.C. for this reason
Date. C/142— Z �Owner: "6 c t4t:� si
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:
Contractor:
MOX ELECTRIC
54225 AVENIDA MENDOZA
LA QUINTA, CA 92253
(760)567-3660
Llc. No.: :LIC -0107359
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 subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date'ZZ %L Applicant: Z ,_
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS - NLAWFUL,
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.
LQegify 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: ZZ /
' Signature (Applicant or Agent)/
I �
FINANCIAL , • 1 .
a�DESCRIPTION ACCOUNT • QTY Ft AMOUNT PAID -DATE
n {.
BSAS SB1473 FEE 101-0000-20306 0•
$1.00 $0.00
PAID BY�r ,METHOD ' " - RECEIPT.# - CHECK•# ,%'
,
_CLTD BYE
w .-
{
Total Paid forBUILDING STANDARDS ADMINISTRATION -BSA $1.00 $0.00
r DESCRIPTION -
A..;ACCOUNT ` ,'
QTY
AMOUNT:",
PAID
5.
PAID DATE!
SERVICES
101-0000-42403
0
$24.17
$0.00
PAID'BY : • : ., .
- ,j xMETHOD
° RECEIPT#
- '- CHECK # 7 a
, .CLTD BY
y DESCRIPTION
ACCOUNT
QTY.
-AMOUNT..`, s
PAID
`PAID DATE
SERVICES PC
101-0000-42403
0
$12.09
- $0.00
s ,'' r . PAID, " •£
METHOD ' '; }`'
T RECEIPT#"
CHECK #
CLTD BY�
x Total Paid for ELECTRICAL: $36.26 $0.00
.=r DESCRIP,TION`. '
ACCOUNT
QTY +
:.:. AMOUNT;`'
{ ` 4 PAID '
PAID DATE
' 4
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
" PAID.BY Y
METHOD ;�
e - RECEIPT #
'-CHECK #,;
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0-
i
I
,g
Permit Details Page 1 of 1
Enter Permit Number `BE ELC2014-1039 _� I ,*Mew<fteport_
14 4 of 2 D DI 0 1i Find I Next El Q til
i
Permit Details PERMIT NUMBER
City of La Quinta BELC2014-1039
Description: PANEL CHANGE OUT 125 TO 200 AMP
SEQID
ADDITIONAL SITES
Type:ELECTRICAL Subtype:
Status: SUBMITTED
Applied: 10/22/2014 PJU
Approved:
Parcel No: 774083005 Site Address: 53330 AVENIDA VALLEJO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 225
lot: 20
Issued:
UNIT21
CONDITIONS
Lot Sci Ft:0 Building Sq Ft: 0
Zoning:
Finaled:,
Valuation: $1,127.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings:0 No. Stories: 0
No. Unites: 0 -
NAME
Details: REPLACE EXISTING PANEL 125 AMP MAIN PANEL TO A NEW 200 AMP MAIN PANEL 2013 CALIFORNIA ELECTRICAL CODE.
INSPECTIONS
SEQID
ADDITIONAL SITES
INSPECTOR-
SCHEDULED
DATE
COMPLETED
DATE
RESULT
CHRONOLOGY
NOTES
E'LE'CTRICAL FINAL**
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
MOX ELECTRIC
54225 AVENIDA
MENDOZA
LA QUINTA
CA
92253
CONTRACTOR
MOX ELECTRIC
54225 AVENIDA
MENDOZA
-. LA QUINTA
CA
92253
OWNER
KRAMER RESIDENCE
53330 AVENIDA
VALLEJO
LA QUINTA
CA
92253
FINANCIAL INFORMATION
DESCRIPTION
- ACCOUNT
QTY
AMOUNT
PAID
PAIDDATE
RECEIPT#
CHECK
METHOD
PAID BY C
BY
BY
BSASSB1473 FEE
101-0000-20306
0
$1.00
$0.00
'
17 Total Paid for BUILDING STANDARDS ADMINISTRATION
BSA:
$1.00
$0.00
SERVICES
101-0000-42403
O'
$24.17
$0.00
SERVICES PC
101-0000-42403
0
$12.09
$0.00
O
Total Paid for ELECTRICAL:
$36.26
$0.00
PERMIT ISSUANCE
101-0000-02404 0
$91.85
$0.00 '
O
Total Paid for PERMIT ISSUANCE:
$91.85
$0.00
,
TOTALS:
$129.11
$0.00
INSPECTIONS
SEQID
INSPECTION TYPE
INSPECTOR-
SCHEDULED
DATE
COMPLETED
DATE
RESULT
REMARKS
NOTES
E'LE'CTRICAL FINAL**
PARENT PROJECTS
Printed: Wednesday, October 22, 2014 4:40:13 PM 1 of 2 ffAF
CRIF7 sysrrns
http://laquinta.crw.comltrakit9lDocumentV iewer.aspx?&report=/DocumentsIPERMITSIP... 10/22/2014
�n
..
Bfi. #
,,
Cl �/ f 1A uln'ta.
.' Buli t a Sarety Divabi n .
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
oil
Permit # '
L
Project Address: _. 33 0
Owner's Name:.
A P. NumberAddress:
,5�3330
Legal Description:.
City, ST, Zip: ..
veva z 25r' �.
Contractor.
Telephone:
Address: S 77 �N
Project Description:
City, ST, Zipt 9 N C Z
Z
Telephone: 40 Q ; ; �s"�riv _` ?•
/liter
State Lic. #: �f / y City Lic. #,
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone•
State Lic. #:
Name of Contact Person:
Construction Type: , Occupancy:
Project type (circle one): New Add'n Alter Demo
Sq. Ft.: r
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Cheek submitted
Item Amount
Strgctucal Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs•
Called Contact Person
Plan Check Balance.
Tide 24 Calm
Pians 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--
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees '
Total Permit Fees