BELC2017-0104J
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
INDEPENDENT ELECTRIC
82-575 AVENUE 62
THERMAL, CA 92274
ELECTRICAL/
BELC2017-0104
51662 EISENHOWER DR
773135008
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
A
NOV 272017
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEF
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm 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.: 93623377/
Date://,o27,/7_ Contractor: (/
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 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 ) 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 Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/27/2017
Owner:
MARGARITA MRAZEK COSS
51662 EISENHDWER
LA QUINTA, CA 92253
Contractor:
INDEPENDENT ELECTRIC
82-575 AVENUE 62 -
THERMAL, CA 92274
(760)578-4707
Llc. No.: 9362-7
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one if 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 rk for which this permit is issued.
W 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: HARTFORD ACCIDENT AND INDEMNfrY COMPANY Policy Number:
_ 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 tfaat, if 1 should become subject t
workers' compensation provisions of Section 3700 of the Labor Co e, I s fort ith
comply with those provisions.
Date: �� O� / % % Applicant:
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 FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to tie Building Official for a permit subject to
the conditions and restrictions set forth on th s application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is perforned 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 isswnce 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 city to enter upon a ab
mentioned property for inspection purposes.
Date://s)?-/? Signature (Applicant or Agent):
t ~
Dater 11/27/2017
s'
Application Number: BELC2017-0104
Owner:
Property Address: 51662 EISENHOWER DR
MARGARITA MIRAZEK COSS
APN: 773135008
51662 EISENHOWER
Application Description:
LA QUINTA, CA 92253 �
Property Zoning:
Application Valuation:
r
Applicant:
Contractor:
INDEPENDENT ELECTRIC
INDEPENDENT ELECTRIC
82-575 AVENUE 62
82-575 AVENUE 62
THERMAL, CA 92274
THERMAL, CA 92274
(760)578-4707
Llc. No.: 936237
Detail: 200A ELECTRICAL SERVICE CHANGE OUT [200A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA
BUILDING CODES.
PANEL CHANGEOUT DUE TO MALFUNCTION BUSSING AND MAIN BREAKER
t
FINANCIAL
DESCRIPTION.
INFORMATION
ACCOUNT QTY
AMOUNT
SERVICES
101-0000-42403 0
$26.01
DESCRIPTION
t
ACCOUNT QTY
AMOUNT
..SERVICES PC
101-0000-42600 0
$13.00
Total Paid for ELECTRICAL:
$39.01
DESCRIPTION
ACCOUNT
QTY
i 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
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$S.00
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Contractor Name:
NeAv S1{D. Construction:
PERMIT # AFLG1011— D 1 Ol)
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PLAN LOCATION
Telephone: 7� d . S7e 7 < Q
Patio/Porch SF
Email: U. I n i (v 0 CJ G e�7mom`)
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`City
Project Address:
State Lic:.. 93? Bus Lic:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
State Lic: City Bus Lic:
APN
I
M
Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email-
Valuation of Project $
Contractor Name:
NeAv S1{D. Construction:
Address: �a,S7� ��
Conditioned Space SF
City, St, Zip j1% C %
Garage SF
Telephone: 7� d . S7e 7 < Q
Patio/Porch SF
Email: U. I n i (v 0 CJ G e�7mom`)
l
`City
Fire Sprinklers SF
State Lic:.. 93? Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:Stories:
Email:
# Units:
Email:
State Lic: City Bus Lic:
.
Property Owner's 124 Name:. rd �� �/A- (Z21�
New Commercial / Tenant Improyemcnts:
Address: N1'--('
Total Building SF
City, ST, Zip�I �3
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000