BELC2017-002978-495 CALLE TAMPICO
c&!t 4 4 Q91A
LA QUINTA, CALIFORNIA 92253 DESIGN. & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0029
Property Address: 49650 COACH ELLA DR
APN: 646230002
Application Description: CAMPBELL/ 100A MAIN BRAKER CHANGEOUT
Property Zoning:
Application Valuation: $250.00
Applicant:
ELITE POWER PLUS
81 - 746 OLEA AVENUE
INDIO, CA 92201
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.: 95418
n
ate: 3 Gong
I her affirm under penalty of perjury that lam 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 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 ) 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
Owner:
MIKE CAMPBELL & ASSOC LD
981 CORPORATE CTR DR 200
POMONA, CA 32253
Contractor:
ELITE POWER ?LUS
81 - 746 OLEA AVENUE
INDI0, CA 92201
(760)578-0574
Llc. No.: 954187
C
Date: 3/28/2017
0
CV
00
Q
1--
z
w
CE
¢ Lu
O
z �
LU
J [L
O O
w
0
z
Z
C'3
cn
w
0
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one Df the following declarations:
1 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 wrk for which this permit is issued.
MR 1 have and will maintain workers' compensation insurance, as required by
Seco 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: NORGUARD INSURANCE COMPANY Policy Number: JAWC700526
_ 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.
Daten�
r 3 Applic'�7Rti JQ '' /(8/
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 appli:ation 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 if La Quinta, its officers, agents, and
employees for any act or omission related to tie 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 cancellatibr•.
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 a er upon the above-
mentioned property for inspection purposes.
bae etI !� Signature:(App licant cr Agent)•.
Applicant:
ELITE POWER PLUS
81- 746 OLEA AVENUE
INDIO, CA 92201
Owner:
MIKE CAMPBELL & ASSOC LTD
981 CORPORATE CTR DR 200
POMONA, CA 92253
Contractor:
ELITE POWER PLUS
81 - 746 OLEA AVENUE
INDIO, CA 92201
Date: 3/28/2017.
(760)578-0574
Llc. No.: 954181
--------------------------------------------------------------------- -------------------
Detail
Application Number:
BELC2017-0029
Property Address:
49650 COACHELLA DR
APN:
646230002
Application Description:
CAMPBELL/ 100A MAIN BRAKER CHANGEOUT
Property Zoning:
Application Valuation:
$250.00
Applicant:
ELITE POWER PLUS
81- 746 OLEA AVENUE
INDIO, CA 92201
Owner:
MIKE CAMPBELL & ASSOC LTD
981 CORPORATE CTR DR 200
POMONA, CA 92253
Contractor:
ELITE POWER PLUS
81 - 746 OLEA AVENUE
INDIO, CA 92201
Date: 3/28/2017.
(760)578-0574
Llc. No.: 954181
--------------------------------------------------------------------- -------------------
Detail
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
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0,
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
- DESCRIPTION
ACCOUNT
QTY
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
Bin #
Permit u
aF�t:a�,f�=vo2q
lProjectFA'ddress:
City of La Q u' in to
Building 8i' Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701.2
Building Permit Application and Tracking ShEet
fo a� Owner -s TJame: �r
J , j�
A. P. Number: �j Z COQ 2A�ddr�s
r
Legal Description:
Ct"•ty7ST�Zip�: O �I C e, "V
2 7
,J
Contractor: �
Al vS
� c
r
llt
�
Te le hone:�
P 0 Z- 0 /
Address: —: % 1_4 0,— i
Proj'ect_Des'rip on:
City, ST, Zip: _ ji'40/4,12
Tele hone: �t� Oo G— OieA
J �: .�
State Lic. # : y
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone-
Xx
e• PancY•
Constructionn TYP Occupancy:
State ic. #:
-type a•r le one),: New Add'n Alter Repair.a"u
'Demo.
oProJ
Na ne of Contact-Pei°son Q14
Sq. Ft.:
# Stories:
# Units:
-Telephone-# of_Contaet!Peison:!�pG
T %g 'L C�
]✓sti3Value ofProject:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balan=e.
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 ContactPcrson
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.0'.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''d Review, ready for corrections/issuc
Developer Impact Fee
Planning Approval
Called Contact Person '
A.I.P.P.
Pub. lVks. Appr
Date of permit issue
Sd106l Fees,
1
•
Total Permit Fecs