BELC2014-1050r
l/
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
RANGEL INC
P 0 BOX 14427
PALM DESERT, CA 92255
�s 4 4aQums
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX(760)777-7011
INSPECTIONS (760) 777-7153
BELC2014-1050 Owner:
43300 CROISETTE CT GHA INC.
609052002 30875 DATE PALM DRIVE
,(1).1;200 AMP METERED COMMERCIAL PEDESTAL CATHEDRAL CITY, CA
$2,500.00
LICENSED CONTRACTOR'S DECLA ION
I hereby affirm under penalty of perjury that I am Iicen d der provisi
9 (commencing with Section 70001 of Division 3 of th Busi ess and Pro
and my License is in full force and effect.
License Class: C�10 License No.: 753548
Date: P l Contractor: rC/
Y
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).: 0
(_) 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 Name
Lender's
Contractor:
RANGEL INC
P 0 BOX 14427
PALM DESERT, CA
(760)360-7377
Llc. No.: 753548
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'
comp sation, as provided for by Section 3700 of the Labor Code, for the performance
ofth rk for which this permit is issued.
tr
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 perm'
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
I certify that in the performance of the work r w ich this permit i ued,
shall not employ any person in any manner so as to be ome ubject to the ers'
compensation laws of California, and agree that, if I s ould ecome subje o the
workers' compensation provisions of Section 3700 o the abor Code, I I for wit
comply with those provisions.
Date: Z -/ / Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION ERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD 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, a sation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the abov nforma on is co'
I agree to comply with all city and county ordinances and state aws rel ing to bui
construction, and hereby authorize representatives of this 'ty ent upon the al
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent)
Date: 12/3/2014
0
)
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'
comp sation, as provided for by Section 3700 of the Labor Code, for the performance
ofth rk for which this permit is issued.
tr
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 perm'
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
I certify that in the performance of the work r w ich this permit i ued,
shall not employ any person in any manner so as to be ome ubject to the ers'
compensation laws of California, and agree that, if I s ould ecome subje o the
workers' compensation provisions of Section 3700 o the abor Code, I I for wit
comply with those provisions.
Date: Z -/ / Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION ERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD 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, a sation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the abov nforma on is co'
I agree to comply with all city and county ordinances and state aws rel ing to bui
construction, and hereby authorize representatives of this 'ty ent upon the al
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent)
(�,�an�Cu L
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CITY OF LA QUANTA
BUILDING & SAFETY DEPT.
.APPROVED
F I CONSTRUCTION
DATE �llq BY
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DESCRIPTION
FINANCIAL ,•
ACCOUNT .
I.
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
POWER APPARATUS
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
PAID
PAID DATE
POWER APPARATUS PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #.
CLTD BY
Total Paid for ELECTRICAL: $48.34 $0.00
DESCRIPTION
ACCOUNTQTY
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: (1) 1,200 AMP METERED COMMERCIAL PEDESTAL
CONDITIONS
Type: ELECTRICAL
Subtype: Status: SUBMITTED
Applied: 12/3/2014 SKH
Approved:
Parcel No: 609052002 Site Address: 43300 CROISETTE CT LA QUINTA,CA 92253
Subdivision:
Block: Lot: E
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $2,500.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
NAME TYPE
Details: ELECTRICAL- (1) 200 AMP METERED COMMERCIAL PEDESTAL. 2013 CALIFORNIA BUILDING CODES.
ADDRESSI
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE,
ZIP
'PHONE
FAX
EMAIL
APPLICANT
RANGEL INC
P O BOX 14427
PALM DESERT
CA
• 92255
(760)969-1400
CONTRACTOR
RANGEL INC
P O BOX 14427
PALM DESERT
CA
92255
(760)969-1400
OWNER
GHA INC.
30875 DATE PALM
DRIVE
CATHEDRAL
CITY
CA
(760)969-1400
DESCRIPTION ACCOUNT` QTY AMOUNT PAID PAID DATE RECEIPT# CHECK#. METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 1 $0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Wednesday, December 03, 2014 1:55:44 PM
1of2
1�SYSTEMS
DESCRIPTION
.' ACCOUNT
..
QTY
AMOUNT
PAID
PAID DATE
RECEIPT#
CHECK#`
METHOD`
PAID BY
CLTD
• BY
POWER APPARATUS
101-0000-42403
0
$24.17
$0.00
POWER APPARATUS PC
101-0000-42600
0
$24.17
$0.00
Total Paid for ELECTRICAL:
$48.34
$0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE:
$91.85
$0.00
TOTALS:00
INSPECTIONS
SEQID. INSPECTION TYPE: INSPECTOR
SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
ELECTRICAL FINAL"
REVIEWS
RETURNED .:>- :-STATUS. REMARKS
REVIEW TYPE ' _ REVIEWER. SENT.DATE DUE DATE DATE.NOTES.
Printed: Wednesday, December 03, 2014 1:55:44 PM 2 of 2 gsrsrenns