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BELC2016-0024LICENSED 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 License No.: 962833 Date: Contractor: 0MV 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 70315 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.). (1 1, 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 whc builds or,improves thereon, and who contracts for the projects with a cbntractor(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: (760)218-1172 Llc. No.: 962833 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 thK3700 for which this permit is issued. have and will maintain workers' compensation insurance, as required by S 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: Applicant:.. 04C OF 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: Signature (Applicant or Agent )• O�i 41 VOICE (760) 777-7125 78-495 CALLE TAMPICO U FAX FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT (760) 777-7153 BUILDING PERMIT Date: 3/14/2016 Application Number: BELC2016-0024 Owner: Property Address: 48890 AVENIDA EL NIDO ROBERT CHAMBERS APN: 658300019 Property Zoning: Application Valuation: $1,200.00 L° 2C' Applicant: Contractor: F J M K ELECTRIC J M K ELECTRIC���� 42225 EVEREST DR 42225 EVEREST DR INDIO, CA 92203 INDIO, CA 92203 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 License No.: 962833 Date: Contractor: 0MV 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 70315 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.). (1 1, 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 whc builds or,improves thereon, and who contracts for the projects with a cbntractor(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: (760)218-1172 Llc. No.: 962833 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 thK3700 for which this permit is issued. have and will maintain workers' compensation insurance, as required by S 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: Applicant:.. 04C OF 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: Signature (Applicant or Agent )• DESCRIPTION FINANCIAL ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 3/14/16 .PAID BY METHOD RECEIPT # CHECK # CLTD BY J M K ELECTRIC DEBIT R13800 RSE Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SERVICES 101-0000-42403 0 $24.17 $24.17 3/14/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY J M K ELECTRIC DEBIT R13800 RSE DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE SERVICES PC 101-0000-42600 0 $12.09 $12.09 3/14/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY J M K ELECTRIC DEBIT R13800 RSE Total Paid for ELECTRICAL: $36.26 $36.26 DESCRIPTION ACCOUNT CITY , AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 3/14/16 PAID BY METHOD RECEIPT # CHECK #, CLTD BY J M K ELECTRIC DEBIT . R13800 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 Description: CHAMBERS / ELECTRICAL PANEL UPGRADE Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 3/14/2016 RSE Approved: Parcel No: 658300019 Site Address: 48890 AVENIDA EL NIDO LA QUINTA,CA 92253 Subdivision: LA QUINTA GOLF ESTATES 1 Block: ' Lot: 92 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,200.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: REPLACE 200 AMP ZINSCO PANEL WITH 200 AMP SQD. 2013 CALIFORNIA BUILDING CODES. Printed: Monday, March 14, 2016 8:35:52 AM 1 of 2 p SYSTEMS ADDITIONAL CHRONOLOGY CONUITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT J M K ELECTRIC 42225 EVEREST DR INDIO CA 92203 CONTRACTOR J M K ELECTRIC 42225 EVEREST DR INDIO CA 92203 OWNER ROBERT CHAMBERS 591 HILLTOP CT WHITEFISH MT 92253 Printed: Monday, March 14, 2016 8:35:52 AM 1 of 2 p SYSTEMS DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY SERVICES 101-0000-42403 0 $24.17 $24.17 3/14/16 R13800 DEBIT J M K ELECTRIC RSE SERVICES PC 101-0000-42600 0 $12.09 $12.09 3/14/16 R13800 DEBIT J M K ELECTRIC RSE Total Paid for ELECTRICAL: $36.26 $36.26 PERMIT ISSUANCE 101-0000-42404 0. $91.85 $91.85 3/14/16 R13800 DEBIT 1 M K ELECTRIC RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: INSPECTIONS l ATTACHMENTS Printed: Monday, March 14, 2016 8:35:52 AM 2 of 2 SYSTEMS Bin # City of La Quin to Building 8i" Safety Division 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Perm it- Applica don and Tracking Sheet Permit # Project Address: Owner's Name: `�y�,f A. P. Number: Address: Legal Description: City, ST, Zip: rao Contractor: r: . L E , r Tele hone: P Address: l�1?ZS�s�yyf� /J� Project. Description: City, ST, Zip: Zi7s/v l/i� l�d1-S3 Z Gr/ Telephone: %l✓1 y / 7Z qCty G A Dv If tJ T- State Lic. Lie. 9:-.00110 49 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ne: n Type: Occupancy:aneY Constructiontructi State Lic. #. Project ty P (circle one): New Add'n Alter Repair air Demo Name of Contact Person: G$ uk� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Nel-, a7/ :11,721 Estimated Value of Project: °ew APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd 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 2nd 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:- '"' 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