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BELC2018-001778-495 CALLE TAMPICO 4 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Permit Type/Subtype: ELECTRICAL/ Owner: Application Number: BELC2018-0017ETHAN GRANT . Property Address: 52813 AVENIDA CARRANZA APN: 773321004 LA QUINTA, CA 92253 Application Description: GRANT/ PANEL UPGRADE ' Property Zoning: Application Valuation: $1,250.00 � Applicant: D Contractor: JEFFREY F KELLNER FEB O S 2018 JEFFREY F KELLNER P 0 BOX 245 P 0 BOX 245 RANCHO MIRAGE, CA 92270 RANCHO MIRAGE, CA 92270 CITY Or LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT (760)774-5333 . Llc. No.: 834358 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: B License No.: 834358 Date: -o/� t `icContractor: _W�AYAIL_ OWNER- ILDE E LARATION 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).: (_) 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 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 ) 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: Date: 2/8/2018 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: EXEMPT Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not em loy any person in any manner sous 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 thos pro ions. Date /;Applicant: WARNING: FAILURE TO SECURE ER CO PENSATION 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 per 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 ' y to enter up%n th above- mentioned /p/r�Dper for inspection purposes. _ &J Dati/ Q Signature (Applicant or Agent): AW Date: 2/8/2018 Application Number: BELC2018-0017 Owner: " Property Address: 52813 AVENIDA CARRANZA ETHAN GRANT APN: 773321004 Application Description: GRANT/ PANEL UPGRADE LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,250.00 Applicant:. Contractor: JEFFREY.F KELLNER JEFFREY F KELLNER P O BOX 245 P 0 BOX 245" RANCHO MIRAGE, CA 92270 RANCHO MIRAGE, CA 92270 (760)774-5333. Llc. No.: 834358 ' Detail: 100A ELECTRICAL SERVICE CHANGE OUT [100A EXISTING] TO A [NEW 200A PANEL)THIS PERMIT DOES NOT INCLUDE RELOCATION OF .EQUIPMENT. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT SERVICES 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT CITY • AMOUNT . SERVICES PC 101-0000-42600 0 $13.00 Total Paid for ELECTRICAL: $39.01 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83. Total Paid for PERMIT ISSUANCE: $98.83 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY. ENHANCEMENT FEE 502-0000-43611 • 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 - ...__._...... _ PERMIT # -PLAN LOCATION: Project Address: �� Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech ' APN #: Telephone: Cid _ �� / 5�� j Patio/Porch SF 0 2d d r�Applicant Name: State Lic: _ City Bus Lic: Address: State Lic: City Bus Lic: ye City, ST, Zip: f Telephone: Email: �f \ y •�J � l t,) � K mac`.. Valuation of Project $ O Contractor Name: New SFD Construction: Addr ,,�. Conditioned Space SF City, St, Zip�� G ZC%C! Garage SF Telephone: Cid _ �� / 5�� j Patio/Porch SF Email: Fire Sprinklers SF State Lic: _ City Bus Lic: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Construction Type: Occupancy: Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: i Property Owner's Name: --� New Commercial / Tenant Improvements: Address: Q�� Total Building SF City, ST, Zip Construction Type: Occupancy: : E 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY ' . , ,. .� '•� , rid � ` a ti. _. , -.... , , # ' 'Submittal`^ "" l " "" `Req'd Recd � t• Plan Sets Structural Calcs Truss Calcs S ,� r Y• Title 24 Calcs - - 4 Soils Report _r . 1 �• 4 .:�., �.� ' e• Grading Plan (PM 10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License