BELC2014-101378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning: ,
Application Valuation:
Applicant:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BELC2014-1013
52095 AVENIDA VILLA'
773233026
PANEL CHANGE OUT /1
$1,500.00
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: CIO License No.: 904511
Date: I I 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 allegil
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 Name:
Lender's Address:
SLI
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/8/2014
Owner:
MIKE RICH
52905 AVENIDA VILLA
LA QUINTA, CA 52253
Contractor:
MENDOZA ELECCRIC
50-313 CALLE TOL05A
COACHELLA, CA 92236
(760)404-7214
Llc. No.: 904511
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o- the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section MG 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 370D of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance --arrier 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 2700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 3 /� Applicant:
WARNING: FAILURE TO SECURE WORKERS' C(3MPEN IONC VERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMILIAL P AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). N ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED F02 IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'SFEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT. -Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit issued
as a result of this application , the owner, and the applicant, each agrees to, and shall
defend, indemnify and hold harmless the City :)f La Quinta, its officers, agents, and
employees for any act or omission related to the work being performe$d,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 issLance of such permit, or cessation of work
for 180 days will subject permit to cancellatio•i.
I certify that I have read this application and s -.ate that the above information is correct.
I agree to comply with all city and county ordi lances 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: '- Signature (Applicant or Agent): _
FINANCIAL •' •
y SCRIP.TION s'ACCOUNTAMOUNTS« ' 3 PAID��P.AID
DATE;%
3 io_
'✓"''F' ..i s"1r:. ..."-': t( _., .a� .-. „...,2.: s... �� i.......'^Mt, as.+, r:...:.3 w '.• � � ,r'x- n t x,.. �. � ..� - u:i4_..c.
BSAS SB1473 FEE
101-0000-20306
0 $1.00 $1.00
8/8/14
PAID:BY +,;?: 3w _" i
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RECEIPT#,, .�-,;..�
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CLTD
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MENDOZA ELECTRIC
CHECK
R664 0539
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Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION �' a s F , '
' E` ACCOUNT.- -!?
AMOUNT
PAIDtDATE,
}QTYv_
. �z`FAID _.�
}
POWER APPARATUS
101-0000-42403
0,
$23.83
$23.83
8/8/14
sPAIDrBY
YMETHOD
RECEIPT:#;
CHECK #�`6
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Y
MENDOZA ELECTRIC
CHECK
R664
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kDESCRIP,TIO
"ACCOUNT..
QTY`
AMOUNT
PAID"�'>
PAID DATE
Y
POWER APPARATUS PC
101-0000-42600
0
$23.83
$23.83
8/8/14
Fti ' rPAID BY
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RECEIPT ^ '
CHECK#
LTD
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,BY
MENDOZA ELECTRIC
CHECK
R664
0539
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Total Paid for ELECTRICAL: $47.66 $47.66
z� �• DESCRIPTION ,:
rte,
= F ACCOUNT:
QTYm
AMOUNTS
PAID '
PAAID DATE..
»: }
t
�
PERMIT ISSUANCE
101-0000-42404
0
$90.57
$90.57
8/8/14
P AID. BY,,:,;-,
METHOD
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RECEIPT
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MENDOZA ELECTRIC
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Total Paid for PERMIT ISSUANCE: $90.57 $90.57
TOTALS: $139.23 $139.23
J
Y
Bin #.. City of La Q urn to "
�. Building Br Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico . .
ILa Quinta;CA 92253 - (760) 777-7012
� BBuilding Permit Application and.Tracking Sheet ,
Project Address: Z, �bJ e� �t�4 Owner's Name: C_
A. P. Number:
Address:
Legal Description:IZe_ZC�eCity,
ST, Zip:jJ�,q CA'
Contract •
or.
— —
Telephone:
Address: " 50-3.13 CA VC `E"�o 0 fit—
Project.Description: e? to. P,, e—. L
City,.ST, zip: - `
Amount
Telephone:hone bo 21`-
A-Cti 't—
�O
G
Reviewed, ready for corrections
Statc Lic. # : C - l O -. ct 014 S 1 (
City Lic. #;
Arch., Engr., Designer.
Address:
Called Contact Person
City, ST, Zip:. '
Plan Check Balance •
Telephone:
w
Occupancy:
CocY�nstruction TYPe:
Project type (circle one): New Add'n Alter Repair Demo
State Lic_ #:
s
Name of Contact Person:
Sq. Ft.: (2po
#Stories: -TV
Units:
Telephone # of Contact Person:
Estimated Value of Project: ( C)o • op .
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrcaionsrissue
Electrical
Subcontactor List
Called ContactPcrson
Plumbing
Grant Decd
Plans picked up
S.M.I.
.' H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'rd Review, ready for correctionsrissue .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
+
Total Permit Pccs