BELC2017-002078-495,CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: BELC2017-0020 /�� Owner:
Property Address: 77329 AVENIDA FERNANDO ® /L\\ ® GOLD COAST MAhfAGEMENT
APN: 658161012—O'"moi 75178 GERALD FORD BR
Application Description: LA QUINTA TENNIS VILLAS / PED S AL ANGE OUT ALM DESERT, CA:92211
Property Zoning: MAR
Application Valuation: $3,000.00 �R
O Z��%
Applicant: DESIGNANDDEVELOPMENT U�NrA contractor:
Clry COCKRELL ELECTRIC INC DEPARTMENT 79553 COUNTRY CLUB DRIVE
79553 COUNTRY CLUB DRIVE
BERMUDA DUNES, CA 92203 BERMUDA DUNES, CA 92203
(760)864-6233
Llc. No.: 725720
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.: 72578 �
Date:. -3-/—/-r 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.).
(1 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. BAP.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: 3/1/2017
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
e work for which this permit is issued.
and will maintain workers' compensation insurance, as required by
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: FALLS LAKE FIRE AND CASUALTY COMPANY Policy Number: FLA003020
I certify that in the performance of tie work for which this permit is issued, I
shall not employ any person in any manner so a to become subject to the workers'
compensation laws of California, and agree tha-, if I should become subject to the
workers' compensation provisions of Section 3X00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 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 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 th 2 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 iesuance 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 representat ves oftbis cityto enter upon the
above-mentioned property for inspection purposes.
Date: �'� _ 7 Signature (Applicant er Agent)
Date: 3/1/2017
AppaicaYlonAumher,,,,, :t_ ,BELC2017.0020 Owner:'
Property'Address: 77329 AVENIDA FERNANDO GOLD COAST MANAGEMENT
APN: 658161012 75178 GERALD FORD BR
Application Description: LA QUINTA TENNIS VILLAS / PEDESTAL CHANGE OUT PALM DESERT, CA 92211
Property Zoning:
Application Valuation: $3,000.00
Applicant: Contractor:
COCKRELL ELECTRIC INC COCKRELL ELECTRIC INC
79553 COUNTRY CLUB DRIVE 79553 COUNTRY CLUB DRIVE
BERMUDA DUNES, CA 92203 BERMUDA DUNES, CA 92203
(760)864-6233
LIC: No.: 725720
--`---------------- --------------------------------------------- ------------------------------
Detail: CHANGE OUT (1) ELECTRICAL PEDESTAL. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL •• •
DESCRIPTION' ACCOUNT
aTY AMOUNT
BSAS SB1473 FEE 101-0000-20306
0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
D.TY
AMOUNT
POWER APPARATUS
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
aTY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$25.33 .
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
aTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
D,TY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
la
Bin # arty 'of La Q uin to
Buifding U Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760).777-701,2
Building Permit Application and Tracking Sheet
l PectAddress: 11•1'! �r�>ra�1�.��17 1.4�QWVC��w"��11VtiS �/i l:V! .fI
Ava"t,- 0� v�ncr�s Name:
A. P. Number: ka' SrrC ,14
q�
dd�r "Q
Legal Description:City„
11 C*w
ST, Zip: e 1
C,oitractor: o
iT e n
Me e ho
P '7 2
Address: 5 S 36in
Pict Description:
City, ST, Zip:
75Se-Mtjtp'&, I>
el
T e h ne•
P-0 Z 3
'
v
S 1 !s 1
W)k -Jk1,ejn)
State Lic. # : 0—/0 2972
City Lic #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
...............................:..::::::::::::::::::::.
i •
Construction
on an
Occupancy:
Type: eY:
State Ltc.#
Pr Ject type (circle one): New Add'n Alter Repair. Demo
0
JLW of Contact Person: ] C -L
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
—�..
iEstinlated Value of Project: �.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
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 Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n° Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
I
Total Permit Fees
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