BELC2015-009378-495 CALLE TAMPICO
LA t1UINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2015-0093
Property Address:
51705 AVENIDA VILLA
APN:
773143022
Application Description:
BROWNYARD / NEW 240 VOLTS 60 AMPS BRANCH CIRCUIT
Property Zoning:
Application Valuation:
$1,000.00
Applicant: D Q
MODERN ELECTRIC'
611 S PALM CANYON DR STE 7519
PALM SPRINGS, CA 92264 FoC T 12 2015
"CITY OF LA OUINTA
COMMUNITY DEVELOPMENT D� NT
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.: 98980
Date: Contracto . ��
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).:
(1 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 cr 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
41
VOICE (760) 777-7125
FAX (760) 777-7011
sC'9N/�/�CD INSPECTIONS (760) 777-7153
Date: 10/12/2015
Owner: .
JAMES BROWNYARD
51705 AVENIDA VILLA
LA QUINTA, CA 92253
Contractor:
MODERN ELECTRIC
611 S PALM CANYON DR STE 7519
PALM SPRINGS, CA 92264
(760)898-9558
Llc. No.: 989800
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 polity 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 700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 1,6Z I ��- 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 st to laws relating to building
construction, and hereby authorize representatives of this c y to ent r upon the
above-me7t'ned roperty for inspection purposes.
Date: Signature (Applicant or Agent .
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT. QTY.::: AMOUNT PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $1.00 $1.00
10/12/15
PAID BY
METHOD' RECEIPT # CHECK #:
CLTD BY
MODERN ELECTRIC
DEBIT R9915
SGU
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00.
DESCRIPTION
ACCOUNT
QTY
AMOUNT '
PAID `
PAID DATE
APPLIANCES, RES
101-0000-42403
0-
$12.09
$12.09
10/12/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
MODERN ELECTRIC
DEBIT
R9915
SGU
DESCRIPTION"
ACCOUNTQTY.-
AMOUNT -;
PAID
PAID: DATE
APPLIANCES, RES PC
101-0000-42600
0
$12.09
$12.09
10/12/15
PAID BY
METHOD
RECEIPT` #
CHECK #
CLTD BY
MODERN ELECTRIC
DEBIT
R9915
SGU
Total Paid for ELECTRICAL: $24.18 $24.18
. DESCRIPTION
ACCOUNT.,
QTY
AMOUNT
.PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
10/12/15
PAID BY
METHOD.
RECEIPT # :
CHECK #:
CLTD BY
MODERN ELECTRIC
DEBIT
R9915
SGU
Total Paid'for PERMIT ISSUANCE: $91.85 $91.85
Description: BROWNYARD / NEW 240 VOLTS 60 AMPS BRANCH CIRCUIT
Type: ELECTRICAL Subtype: Status: UNDER REVIEW
Applied: 10/12/2015 SGU
Approved:
Parcel No: 773143022 Site Address: 51705 AVENIDA VILLA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 112 Lot: 10
Issued:
NO 12
PHONE
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
92264
Details: NEW 240 VOLTS 60 AMPS BRANCH FOR NEW A/C PER 2013 CALIFORNIA BUILDING CODES
CHRONOLOGY
CONDITIONS
NAME TYPE NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX EMAIL
APPLICANT MODERN ELECTRIC
611 S PALM CANYON
DR STE 7519
PALM SPRINGS
CA
92264
(760)562-1735
CONTRACTOR MODERN ELECTRIC
611 S PALM CANYON
DR STE 7519
PALM SPRINGS
CA
92264
(760)562-1735
OWNER JAMES BROWNYARD
51705 AVENIDA VILLA
LA QUINTA
CA
.922S3
(760)562-1735
FINANCIAL INFORMATION
Printed: Monday, October 12, 2015 8:05:24 AM 1 of 2
' SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD.
BY
BSAS 561473 FEE
101-0000-20306
0
$1.00
$1.00
10/12/15
R9915
DEBIT
MODERN ELECTRIC
SGU
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
APPLIANCES, RES
101-0000-42403
0
$12.09
$12.09
10/12/15
R991S
DEBIT
MODERN ELECTRIC
SGU
APPLIANCES, RES PC
101-0000-42600
0
$12.09
$12.09
10/12/15
R9915
DEBIT
MODERN ELECTRIC
SGU
Total Paid for ELECTRICAL: $24.18 $24.18
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
10/12/15
R9915
DEBIT
MODERN ELECTRIC
SGU.
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:i
ATTACHMENTS
Printed: Monday, October 12, 2015 8:05:24 AM 2 of 2. Com® :
SYSTEMS
Bin
City of La Quinta
Building 8& Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
Project Address:` 1
Owner's Name:
A. P. Number: ®W4rD , C.l► 5223
.
Address: e �-
Legal Description: t1V-n /yL,
City, ST, Zip:
Contractor:
ne•
Tele P ho .
Address: ' i t-,\r
Project Description: ,� V' A
City, ST, Zip:V4L14 F,,- C& . �.%M)9—&ArUr
nc�
Telep h o .
State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: one:
P
Con tructi n T O c ane
s o Type: P P Y:
Lic. #:
Project nPa circle one): New TdTnAlter' Repair. Demo
Name of Contact Person:
Sq. Ft.:�
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: �r
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Sobeontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
I ,O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''J 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