BELC2017-011078-495.CALLE TAMPICO
LA QOINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:'
Property Zoning:
Application Valuation:
ELECTRICAL/
BELC2017-0110
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
49650 DATE PALM DR
646070009
MASTERS / 200 AMP PANEL CHANGEOUT
$7,908.00
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD #201
MEMPHIS, TN 38120
D
qa
DEC 12 2017
CITY F LA QUINTA
DESIGN AN DEVEI
LOP ENDEPARTMENT
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 *Businessanessio de, andmy License is in full force and effect.
License Class: C3 C30 20 License No.: 5 'Safe: Co�ctor:
OWNER -8 R DECLA
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 Q
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 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 Addref
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/12/2017
Owner:
LOVANN MASTERS
49650 DATE PALM DR
LA QUINTA, CA 92253
Contractor:
A R S AMERICAN RESIDENTIAL SERVICES OFC
965 RIDGE LAKE BLVD #201
MEMPHIS, TN 38120
(951)276-9744
Llc. No.: 7650;1
WORKER'S COMPEN!ATION DECLARATION
I hereby affirm under penalty of perjury oneof the following declarations:
FcI have and will maintain a certificate of consent to self -insure for workers'
pensation, as provided for by Section 3100 of the Labor Code, for the performance
of th rk for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Se on 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: LIBERTY INSURANCE CORPORATION Policy Number: WA763DS08631017
_ 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 1 ould beco3e,1
est to the
workers' comp nsation provisions of Sectiai 37 of he C rthwcomply wions.
Date:A� ant:WARNING: FAILURE TO SECURE WOR S' .OMPENSATIO IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($10Cx000). 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 -his 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 C ty of La Quints, its officers, agents, and
employees for any act or omission related 10 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 fesuance 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 building
construction, and hereby authorize representatives of this t .nter u e-
me�ntioned p pert or inspection purposes.
D*
(Z /7 Se (Applicant or A nt):
Date:' 12/12/2017
Application Number: BELC2017-0110
Owner:
Property Address: "°" 49650 DATE PALM DR
LOVANN MAS—ER5
APN: 646070009
49650 DATE PALM DR
Application Description: MASTERS / 200 AMP PANEL CHANGEOUT
LA QUINTA, CA 92253
Property Zoning: ,
Application Valuation: $7,908.00
Applicant:
Contractor:
A R S AMERICAN RESIDENTIAL SERVICES OF C
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD #201
965 RIDGE LAKE BLVD #201
MEMPHIS, TN 38120
MEMPHIS, TN 38120
(951)276-9744
-------------------------------------.-------------------------------------------------------
Llc. No.: 765074
Detail: .200 ELECTRICAL SERVICE CHANGE OUT [200A EXISTING] AND 50A DEDICATED CIRCUIT WITH PLUG'FOR RV THIS PERMIT DOES NOT INCLUDE
RELOCATION OF EQUIPMENT. 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNTQTY AMOUNT
BSAS,SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRAT:,ON BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$3.71
Total Paid for Credit Card Fee: $3.71
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT PC
101-0000-42600
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600 _
0
$13.00
Total Paid for ELECTRICAL: $91.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE:- $98.83
DESCRIPTION
ACCOUNT
QTY
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
0
i
Total Paid for TECHNOLOGY ENHANCEM ENT FEE: $5.00
Bin.#
Qty. of La Quintd
Building at Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sbeet
Permit #
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Project Address: (4:tj04Z "DcA �i%A r
Owner's Name:.
Mas L�u�.r,+
A. P. Number.
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Address: G S Gj�•K—
Legal Description:
City, ST, Zip: Z,Z
Contractor: �..� '�,i►2_
Tele hone• .
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Address:?.
ProjectDescription-
City, ST, Zip: Z V a z5z J_
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!O S16State
Telephone: 8� �o�a 0497�
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_S3'1..
Lic. #:A60 77
City Lic. the
Arch, Engr., Designervo
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Address:
Cv
City., ST, Zip:
Telephone:. ;
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n.' ter epair Demo
Sq. Ft.: #Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Calci.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Pian Check Balance.
Title 24 Calci.
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
tad Review, ready for corrections/issue
Electrical
Subcontactor Lfst
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
3" Review', ready for eorreetions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees