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BELC2015-004978-495 CALLE TAMPICO VOICE (760) 777-7125 RA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/1/2015 Application Number: BELC2015-0049 Owner: Property Address: 51420 CALLE JACUMBA RIC JACKSON APN: 770166024 51420 CALLE 1ACUMBA Application Description: JACKSON RESIDENCE ELECTRICAL PANLE UPGRADE LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,500.00 Applicant: U 015 Contractor: WEST BOUND ELECTRICAL CONTRACT 11 1`j WEST BOUND ELECTRICAL CONTRACT 74-170 HWY 111 STE 3 •1V 74-170 HWY 111 STE 3 PALM DESERT, CA 92260 C1� 0�1A��pA pF1M``�j PALM DESERT, CA 92260 GOMMUN�� GIEN� (760)776-8314 Llc. No.: 786678 LICENSED CONTRACTORS 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.: 786678 Date: J / I Contractor.L 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 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 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: S 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: 45 Signature (Applicant or Agent):. DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE- BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # 'CHECK # CLTD BY 'Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION. ACCOUNT QTY AMOUNT PAID PAID DATE SERVICES 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD RECEIPT# • CHECK# CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SERVICES PC 101-0000-42403 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $36.26 $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 forPERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 Bin # City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle-Tampico La Quinta, CA 92253 - (760) 777-7012. 00" Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: L —�O�� 5>0,v\- Ov\- A. A. P. Number: �� l2'LS.3 Address:5 'z Ca ,ala v� Legal Description: City, ST, Zip:CA ,�� Contractor: FP ' W �S �" T ele h n , P o e: Address: -714 -1-7 O Project Description: Gi..e1L City, ST, Zip: A CAA Telephone: le h Po . �b ? (o o' 7 t State Lic. # : —7 a(p 't 8 City Lie. Arch., Engr., Designer: Address: l City., ST, Zip: h Telephone: one: Con tru ' T s ctt n o e: Occupancy: Type: cuPancY• • State Lic. #• Project type (circle le one):: New Add'n Alter Repair Demo Name of Contact Person: rN Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: -') (O0 — 9-3 0.— 0'3> L4 Estimated Value of Project: ` 6TH APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. 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 tad 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:- 3' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Description: JACKSON RESIDENCE ELECTRICAL PANLE UPGRADE ADDITIONAL Type: ELECTRICAL Subtype: Status: APPROVED Applied: 7/1/2015 EVA Approved: 7/1/2015 EVA Parcel No: 770166024 Site Address: 51420 CALLE JACUMBA LA QUINTA,CA 92253 Subdivision: DESERT CLUB TR UNIT 2 Block: 2 Lot: 16 Issued: Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $1,500.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: ELECTRICAL/ CHANGE ELECTRICAL PANEL 2013 CBC ADDRESSI 7PALMDYESERT STATE Printed: Wednesday, July 01, 2015 11:42:39 AM 1 of 2 ? 4YSTrMS ADDITIONAL CHRONOLOGY CONDITIONS NAME TYPE NAME ADDRESSI 7PALMDYESERT STATE ZIP PHONE FAX EMAIL APPLICANT WEST BOUND ELECTRICAL CONTRACT 74-170 HWY 111 STE 3 CA 92260 ( CONTRACTOR WEST BOUND ELECTRICAL CONTRACT 74-170 HWY 111 STE 3 PALM DESERT CA 92260 ( OWNER . RIC JACKSON 51420 CALLE 1ACUMBA LA QUINTA CA 92253 ( Printed: Wednesday, July 01, 2015 11:42:39 AM 1 of 2 ? 4YSTrMS DESCRIPTION ACCOUNT QTY. AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY LTD CBY BY SERVICES 101-0000-42403 0 $24.17 $0.00 SERVICES PC 101-0000-42403 0 $12.09 $0.00 Total Paid for ELECTRICAL: $36.26 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 I $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:$0.00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES ELECTRICAL FINAL" BLD Printed: Wednesday, July 01, 2015 11:42:39 AM 2 of 2 SYSTEMS �1— x-120 �e �