BELC2016-003678-495 CALLE TAP�PICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BELC2016-0036
Property Address:
58615 JEREZ
APN:
764650006
Application Description:
DOKA /INSTALL CHARGING STATION INTO GARAGE
Property Zoning:.
Application Valuation:
$525.00
Applicant:
VINTAGE E & S INC
49950 JEFFERSON STREET 130-388
INDIO, CA 92201
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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 C46 (� License No.: 4813
Ornate. '1.`r Contractor-AtK
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).:
U 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 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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 polity number are:
Ca r: _ Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shal 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: 4 ` �' Applicant:
r
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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: T Signature (Applicant or Agent):
Date: 4/7/2016
Owner:
MIKE DOLKA�
58615JEREZ
LU
LA QUINTA, CA 92253
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Contractor:
S O
VINTAGE E & S INC
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49950 JEFFERSON STREET 1L38
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INDIO, CA 92201
(760)775-0135
Llc. No.: 481352
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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.
-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:
Ca r: _ Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shal 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: 4 ` �' Applicant:
r
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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: T Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL .
ACCOUNTQTY
.
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCES, RES
101-0000-42403
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT "
PAID
PAID DATE,
APPLIANCES, RES PC
101-0000-42600
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $24.18 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #CHECK
#
CLTD BY.
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Description: DOKA / INSTALL CHARGING STATION INTO GARAGE
Type: ELECTRICAL
Subtype: Status: ON HOLD
Applied: 4/7/2016 SKH
Approved:
Parcel No: 764650006 Site Address: 58615 JEREZ LA QUINTA,CA 92253
Subdivision: TR 31681-3
Block: Lot: 6
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $525.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
STEPHANIE KHATAMI
Details: INSTALL CAR CHARGER INTO GARAGE. 2013 CALIFORNIA BUILDING CODES.
4/7/2016
Printed: Thursday, April 07, 2016 10:56:38 AM 1 of 2 Jr
SYSTEMS
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE NOTES
NOTE
STEPHANIE KHATAMI
4/7/2016
4/7/2016
ON HOLD UNTIL CSLB IS CLEAR.
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
VINTAGE E & S INC
49950 JEFFERSON
STREET 130-388
INDIO
CA
92201
CONTRACTOR
VINTAGE E & S INC
49950 JEFFERSON
STREET 130-388
INDIO
CA
92201
OWNER
MIKE DOLKA
58615 JEREZ
LA QUINTA
CA
I 92253
Printed: Thursday, April 07, 2016 10:56:38 AM 1 of 2 Jr
SYSTEMS
f t• Permit Details PERMIT NUMBER
�City of La Quinta BELC°,20i16.0036MW
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID.
PAID DATE
RECEIPT #
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:
APPLIANCES, RES
101-0000-42403'
0
$12.09
$0.00
APPLIANCES, RES PC
101-0000-42600
0
$12.09
$0.00
Total Paid for ELECTRICAL: $24.18 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
PARENT PROJECTS
Printed: Thursday, April 07, 2016 10:56:38 AM 2 of 2 V?
SYSTEMS
VIN.TAME
E.L E C T R I .0
�ara9�
CIS OF LA 4DE
BUILDING & SA
APPROVED
FOR-CONSTID.ATE 1 ILB
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49950 Jefferson Street, 130-388 ® Indio CA 92201 e Phone 760-775-0135
Bin #
City of La Quin to
Building &" Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: „ C�g►b I ��
Owner's Name: "1 Kea, 4-{i
A. P. Number:
Address:�— 4-4 ,
S �p I ,Str i'z.
Legal Description:
City, ST, Zip:
Contractor: l
CI V
ele hone•
TP
Address:4J,
Project
Project Description: 5 0 A z, �Q Y-
ST, Zip: I h ..� . LA ZZA 1
Telephone: V O
Z � s. 1
1 a 3S
State Lic. #:
City Lic. 9:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: ele h
one:
n struct T
Co i n
o e: Occupancy:
Type: P Y:
State Lic. #:
Prtype e ( circle one)• New Add'n t
J AI er Re P air Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: SZ
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 Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan .
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Jrd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
-School Fees,
Total Permit Fees