BELC2017-002378-495 CALLE TAMPICO
Ti. .4 409&ro
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0023
Property Address: 52810 AVENIDA DIAZ
APN: 773312005
Application Description: MYERS / UPGRADE FROM 125AMP TO 200AMP
Property Zoning:
Application Valuation: $2,500.00
Applicant:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C30 License No.: 904511
,002 E % Contractors
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).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DEBBIE MYERS
52810 AVENIDA CIAZ
LA QUINTA, CA 9253
Contractor:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
Date:
3/1/2017
I—
z
w
CE
LU
LU
z �
a
O
�O
Q
U Q
z
(760)404-7214 CD
Llc. No.: 9045119
13
WORKER'S COMPENSATON 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 370C 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
Sectioh 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insuranc- carrier and policy number are:
Carrier: CITIZENS INSURANCE COMPANY OF AMERICA Policy Number:
I certify that in the performance of :he work for which this permit is issued, 1
shall not employ any person in any manner so 3s to become subject to the workers'
compensation laws of California, and agree thct, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant! 1GOcw.
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 FOF 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 thi_ 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 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 appliotion becomes null and void if work is
not commenced within 180 days from date of ssuance 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 representacives of this city to enter upon the
above-mentioned property for inspection purposes.
Date Signature (Applicant or A Qnt):
Detail: ELECTRICAL - UPGRAGE PANEL FROM 12SAMP TO 200AMP. 2016 CALIFORNIA BUILDING CODES.
Date: 3/1/2017
Application Number:
BELC2017-0023
Owner:
Property Address:
52810 AVENIDA DIAZ
DEBBIE MYERS
APN:
773312005
52810 AVENIDA D^AZ
Application Description:
MYERS / UPGRADE FROM 125AMP TO 200AMP
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$2,500.00
Applicant:
Contractor:
MENDOZA ELECTRIC
MENDOZA ELECTRIC
S0-313 CALLE TOLOSA
50-313 CALLE TOLOSA
COACHELLA, CA 92236
COACHELLA, CA 9-236
(760)404-7214
LIc. No.: 904511
Detail: ELECTRICAL - UPGRAGE PANEL FROM 12SAMP TO 200AMP. 2016 CALIFORNIA BUILDING CODES.
Date: 3/1/2017
t
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
$25.33
DESCRIPTION
ACCOUNT
aTY
AMOUNT
SERVICES PC
101-0000-42600
0
$12.67
Total Paid for ELECTRICAL: $38.00
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
r
Bin >`#.,, �'
Permit ##
Project Address:_
s
C[ ty of La Quin to
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Shl?et
�Owner's Nae: ea 4 ve)..�� L6 ! / r / • • P 1�.
A. P. Number:
Address:
Legal Description: EICt;�/` C'G3
City, ST, Zip: ,t r
y�
Contractor: '
O� l% i
L C G
TelePhn•
o c.
Address: S-0 -:3. /3 C!9LLLe
—To- IO SIl-
Project Description:
City, ST, Zip:
Telephone:
one: t� Y �y
State Lic.
City Lic. #..
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
ele h
Po .
n on T e: cc ane
Costructi Occup
YP P Y•
,
State. Lic. # •
Project type circle one): New Add'n Alter Repair. Demo
ame of Contact Person:
Sq. Ft.:
# Stories:
# Units:
elephone # of Contact Person: 7 Go
_ yo _ ��
timated Value of Project: 25-0 Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
tl
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Clieck Deposit
Truss Calcs.
Called Contact )Person
Plan Check Balarce.
Tile 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrcctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN If0USE:-
'"! Review, ready for corrections/issue
Developer ImpacA Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date or permit issue
School Fees,
Total Permit Fees