BELC2016-0013a
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BELC2016-0013
Property Address:
50800 GRAND TRAVERSE AVE AVE
APN:
770320060
Application Description:
NELSON / CHANGE OUT 200 AMP PANEL
Property Zoning:
50800 GRAND TRAVERSE AVE
Application Valuation:
$2,500.00
Applicant:
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JP ELECTRICAL POWER AND CONTROLS
4634 VIA LA QUINTA
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YORBA LINDA, CA 92886
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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 Licehse is in full force and effect.
License Class: C10 License No.: 633319
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Date: a—ZZ—Yz 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 exem_pUherefrom 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
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(__j I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
( ) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work -for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's
10
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of th work for which this permit is issued.
I_have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
i i sued. Mu worompens� n insurance carrier and policy number are:
C er: GJC �yLZ$Q
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: &;4a =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.
Datev`�r/b2Z—lG Signature (Applicant or Agent):
Date: 2/22/2016
Owner:
ROBERT NELSON
50800 GRAND TRAVERSE AVE
LA QUINTA, CA 92253
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Contractor:
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JP ELECTRICAL POWER AND CONTRO'L
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4634 VIA LA QUINTA
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YORBA LINDA, CA 92886
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(562)644-4638
ME
Llc. No.: 633319
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 th 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
i i sued. Mu worompens� n insurance carrier and policy number are:
C er: GJC �yLZ$Q
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: &;4a =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.
Datev`�r/b2Z—lG Signature (Applicant or Agent):
P,
FINANCIAL INFORMATI N
.......... _J
DESCRIPTION''' ION'
v
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.0.0
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1H OW '00,
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Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.06
DESCRIPTIONON- N44�,
E ACCOUNT
01%
AMOUNTr
AI E�
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SERVICES
101-000042403
0
$24.17
$0.00
BY _
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1PAID
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C H E K
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!%,ffi ZPAID,' E.Q
V A- I R DATE
R
1, -low
SERVICES PC
101-0000-42600
0
$12.09
$0.00
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4>111�1:?�NAI:Z!�q�.-
AECEI!
-M -0,
ECK #
-1TW BY,
2, Pill,
'Total Paid for, ELECTRICAL: $36.26 $0.001
EsIcklOndw-13
Ot. 101
gt
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
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CEIPT4U
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lZt-,2 W41
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total:Paid for, PERMIT. ISSUANCE:. $91.85 $0.00
O-,$0 00.
A TTALS:::,
Description: NELSON / CHANGE OUT 200 AMP PANEL
Type: ELECTRICAL .
Subtype: Status: APPROVED
Applied: 2/22/2016 SKH
Approved: 2/22/2016 SKH
Parcel No: 770320060 Site Address: 50800 GRAND TRAVERSE AVE AVE LA QUINTA,CA 92253
Subdivision: TR 25389-3
Block: Lot: 60
Issued:
Lot Scl 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
Details: CHANGE OUT (1) 200 AMP PANEL LIKE FOR LIKE, NOT MOVING LOCATON. 2013 CALIFORNIA BUILDING CODES.
CONDITIONS
FINANCIAL INFORMATION
Printed:. Monday, February 22, 2016 10:11:18 AM 1 of 2
CVW SYSTEMS
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:
SERVICES
101-0000-42403
0
$24.17
$0.00
SERVICES PC
101-0000-42600
0
$12.09
$0.00
Total Paid for ELECTRICAL: $36.26 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:$0.00
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Monday, February 22, 2016 10:11:18 AM 2 of 2
SYSTEMS