BELC2018-0015t
it,
78-495.CALlF:TAMP.ICO , . C �
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
Application Number:
Property Address:.
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
JESUS ESCAMILLA
52945 AVENIDA MARTINEZ
LA QUINTA, CA 92253
ELECTRICAL/
BELC2018-0015
52945 AVENIDA MARTINEZ
773331024
SJOQUIST / ELECRICAL PANEL UPGRADE FROM 100 TO 200 AMPS
$600.00
13 0 /0013
CITY OF LA QUINTA
COWil',INITY DEVELOPMENT DEPART6IENT
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: License No.:
=Date: 7 r Contractor:
OWNER -BUILDER DECLARATION
1 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).:
lompenas owner of the property, or my employees with wages as their sole
sation, will do the work, and the structure isnot intended or offered for said.
(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 did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to
nstruct 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
on rs' State License Law.).
I am exempt under Sec. B.&P.C. for thi on
Date:' Ow er:'
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a constructionlending 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
Date: 2/7/2018
Owner:
CYNTHIA SJOQUIST
524 MINNEAPOLIS AVE
GLADSTONE, Mf 92253
Contractor:
OWNER BUILDER
Llc. No.:
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
of the work for which this permit is issued. .
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:
Ca ier: Policy Number:
ocertify that in the performance of the work for which this permit is issued, I
41f�7emp.1
oy 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. ^
Date: Applica
WARN N : FA URE 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 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 issuance of such permit, or cessation of work
for 180 days will subject permit to cancellation.
I certify that 1 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 the above-
mentioned property for inspection purposes.
Date: =� Signature (Applicant or ent):
i
Date: 2/7/2018
Application Number: BELC2018-0015
Owner:
Property Address: "' 52945 AVENIDA MARTINEZ
CYNTHIA SJOQUIST
APN: 773331024
524 MINNEAPOLIS AVE
Application Description: SJOQU15T / ELECRICAL PANEL UPGRADE FROM 100 TO 200 AMPS
GLADSTONE, MI 92253
Property. Zoning:
Application Valuation: $600.00
Applicant:
Contractor:
JESUS ESCAMILLA
OWNER BUILDER
52945 AVENIDA MARTINEZ
LA QUINTA, CA 92253
-----------
Llc. No.:
----------------------------------------------------------------—----------------
Detail: UPGRADE ELECTRICAL PANEL FROM 100AMP TO 200 AMP ONLY. THIS PERMIT DOES NOT INCLUDE RELOCATION OF ANY EQUIPMENT. PER 2016
CALIFORNIA ELECTRICAL CODE.
�. r
FINANCIAL INFORMATION
:DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
Total Paid for ELECTRICAL: $39.01
ACCOUNT QTY AMOUN
101-0000-42404 0 $98.83
Total Paid for PERMIT ISSUANCE: $98.83
ACCOUNT QTY AMOUN
101-0000-42416 0 $10:00
Total Paid for, RECORDS MANAGEMENT FEE: $10.00
DESCRIPTIONT
DESCRIPTION
ACCOUNT
QTY
AMOUNT
AMOUN
TECHNOLOGY ENHANCEMENT FEE
Credit Card Fee
101-0000-43505
0
$2.75
Total Paid for ELECTRICAL: $39.01
ACCOUNT QTY AMOUN
101-0000-42404 0 $98.83
Total Paid for PERMIT ISSUANCE: $98.83
ACCOUNT QTY AMOUN
101-0000-42416 0 $10:00
Total Paid for, RECORDS MANAGEMENT FEE: $10.00
DESCRIPTIONT
ACCOUNT
QTY
AMOUN
TECHNOLOGY ENHANCEMENT FEE
502-0
000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Total Paid for ELECTRICAL: $39.01
ACCOUNT QTY AMOUN
101-0000-42404 0 $98.83
Total Paid for PERMIT ISSUANCE: $98.83
ACCOUNT QTY AMOUN
101-0000-42416 0 $10:00
Total Paid for, RECORDS MANAGEMENT FEE: $10.00
DESCRIPTIONT
ACCOUNT
QTY
AMOUN
TECHNOLOGY ENHANCEMENT FEE
502-0
J
w�vr
W W
PERMIT # 2 E L.0 L (L (001 .S
PLAN LOCATION:
Project Address:_ �S ,
VL
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech,.
APN #:U-ge
d —'
IQOW4 106 10
Garage SF
Telephone:
Applicant Name: vs S CAW ((�—
Patio/Porch SF
Address: �O
/VV A-)
role
City, ST, Zip:. + C Cl :a-2
3
Telephone:
Email:�� S /�� 111-14Valuation
.J
of Project $� �a v
Cal,h
Contractor Name:11 C + C-04_,6
New SFD Construction:
Address:
//gs- 1!0-1,17 11e �I A�e
Conditioned Space SF
City, St, Zip
Telephone:
Garage SF
Telephone:
��0 ;.-.� S _ qV7
Patio/Porch SF
Email:
/VV A-)
Fire Sprinklers SF
State L' ic:.'1
7 City Bus Lic:
Arch/Eng Name:
Construction Type: , Occupancy:.
Address:
'Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: �'.�,��. S `s New Commercial / Tenant Improvements:
Address: Gf 4 e—n, 2i Total Building SF
City, ST, Zip Q Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA Q.UINTA, CA 92253
. 760-777-7000
C��anciall
understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
or personal injuries -sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
(;2I understand I may obtain more information regarding my, obligations as an.'- employer" from the Internal Revenue
ice, the United States Small -Business Administration, the California Department p ent of Benefit Payments, and the California
Division of Industrial Accidents..I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
�0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally, and financially responsible for proposed construction activity at the following address:
I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers.
/�1.2: I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
"Kve provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board.may be unable to assist you with any financial loss
you may sustain as a result•of a complaint. Your only remedy against unlicensedContractors may be in civil cot.'
important is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note, A copy of the property owner's driver's license, form notarisation, or
other verification acceptable to the agency is required to be presented when the permit is issued .to verify the property
owner's signature. , _ _ .--'� •
Signature of pro'
per�y� wger •• --- ��_,Z, Date: 2,-
Note:
,^
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act asmy agent(s) to apply for, sign; and file the documents necessary to obtain an Owner -Builder
Permit for my project..
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.
Property Owner's Signature: Date:
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT -
PROPERTY OWNER'S PACKAGE
(760)777 -7012
FAX (760)777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been subrriitted in your name listing yourself as the builder of the property .
improvements specified at S��J f.�s �t/P,��pIA Erb .A.�t�G
We are providing you with an Owner -Builder Ac ahowledgment and Information Venfrcation Form to make you aware of. your.
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS.- Read and initial each statement below to signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally: I, as .
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
!s
2 'I understand building permits are not required to be signed by property owners unless they are responsible for the
L construction and are not hiring a licensed Contractor to assume this responsibility.
L. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own
L=am 4. I understand Contractors are required by law to be licensed and bonded in California rnia and to list thea license numbers on
permits and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
Cdf my construction is at least five hundred dollars ($500), including labor and materials, 1 may be considered an "employer"
under state and federal law.
6�. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial
risk.
�7understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
nnot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or .all of the work is performed.
under contract with a licensed general building Contractor.
ry
♦
i
Armando Magallon
From:. s Cindy Sjoquist <8pawz4cindy@gmail.com>
Sent: Tuesday, February 6,.2018 12:46 PM
To: Armando Magallon
Cc: Wayne Walker
Subject: Permit Request for 52945 Avenida Martinez
Mr. Magallon,
Per our'phone.,conversation, yesterday, I have attached -a letter :and. my ID,
requesting a permit for my electrician to make repairs on -my rental
property.. I could not get my license any. lighter.:
A copy is being forwarded to my Property Manager, Wayne
Walker. Thank you for your assistance.
Sincerely,
Cindy S j oquist
Tuesday, February 6, 2018
To: amagallon@la-quinta.org
Permit Office, City of La Quinta, CA
From: Cindy Sjoquist
906-428-9103
Sir,
I, Cynthia Sjoquist, am the owner of the property at 52945 Avenida Martinez, in the City of La Quinta,
CA. I authorize Jesus Escamilla and/or Francisco Robledo Nunez to obtain a permit from the City on my
behalf to install and upgrade the electrical panel from 100 Amp to 200 Amp on my rental property at the
address stated above.
Sincerely,
l
Cc: Property Manager Wayne Walker, 760-469-6173
Att: copy of Sjoquist ID
v