BELC2017-006278-495 CALLE TAMPICO D 14P Qumrcu
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
Applicant:
BUILDING PERMIT
Application Number:
BELC2017-0062
Property Address:
80960 BELLERIVE
APN:
775350004Application
Description:
Property Zoning:
GLEASON RESIDENCE / ELECTRICAL
® 2017Application
FE
Valuation:
$15,000.00
-
DON HEGGE ELECTRIC
75101 SEGO LN STE D
PALM DESERT, CA 92211
Cl y0FLgQUiNTA IJ
COMMU! NITM DFyEfOPMdVi DEPMTM
----.__,__ ENT
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: CSO License No.: 49194c}=2,.- I
*ate: l ^ 0— 24 C )actor:
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, 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/2017
Owner:
DANIEL GLEASON
80960 BELLERIVE
LA QUINTA, CA 92253
Contractor:
DON HEGGE ELECTRIC
75101 SEGO LN STE D
PALM DESERT, CA 92211
(760)340-4000
Llc. No.: 491949
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 policy number are:
Carrier: PREFERRED EMPLOYERS INSURANCE COMPANY Policy Number:
W KN 1247351
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 Seon 3 of the La bo C de, I shall forthwith
comply with those provisions.
Date: 7.16 17 Ap}licant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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
I agree to comply with all city and county ordinances ands a la
construction, and hereby authorize representatives of thisity to
above-mentioned property for inspection purposes. �
Dat@ 7� S�nature (Applicant or Agent)
information is correct.
tqs relatigg jo building
Date: 7/10/2017
Application Number: BELC2017-0062 Owner:
Property Address: 80960 BELLERIVE DANIEL GLEASON
APN: 775350004 80960 BELLERIVE
Application Description: GLEASON RESIDENCE/ ELECTRICAL LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $15,000.00
Applicant:
Contractor:
DON HEGGE ELECTRIC
DON HEGGE ELECTRIC
75101 SEGO LN STE D
75101 SEGO LN STE D
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)340-4000
Llc. No.: 491949
Detail: INSTALL BACKUP GENERATOR 22 KW NATURAL GAS. PER 2016 CALIFORNIA BUILDING CODE
Ki+
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00.
FINANCIAL
DESCRIPTION
INFORMATIOW,
ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
POWER APPARATUS
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00.
Bili#
City of la Quetta
Building 8r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 6 e
Owner's Name: > J 1 C )
A. R Number:
Address: l
Legal Description:
City, ST, Zip: An e
Contractor:T)01 A37z L
Telephone:
Address: Q Liz/
Project Description:
City, ST, Zip: 4I
ti L
Telephone:h
e.U W
/Ac
2 I 14, Yp
State Lic. # :
City Lie_ #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
::>_;?;>s:<::::;;;:;;:;.:
..
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'nAlter Repair Demo
Name of Contact Person: e—Sq.
Ft:
# Stories:
# Units:
Telephone # of Contact Person: J
Estimated Value of Project: ,% . A 0 0
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 forcorrections
Plan Check 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 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:-
3a 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