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BELC2018-00347S4. 95. CALLE.. TAM P..I CO .. LAtQUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: JOSEPH TROMBINO 38801 NELSON ROAD RANCHO MIRAGE, CA 92270 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 .FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/13/2018 ELECTRICAL/ Owner: BELC2018-0034 DAVID QUESENBERG 51105 AVENIDA MENDOZA 51105 AVENIDA MENDOZA 773073009 LA QUINTA, CA 92253. QUESENBERG / PANEL CHANGEOUT SAME SIZE AND LOCATION $4,000.00 MAR .13 2018 CITY OF LA QUINTA CAMM UN1 iY DEVELOPMENT DEPARTMENT 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 CI s: 010 License No.: 965837 Date: �b Contractor: OWNER-BUI CLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 703 1.5, 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).: (� 1, 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. . 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 Contractor: JOSEPH TROMBINO 38801 NELSON ROAD RANCHO MIRAGE, CA 92270 (760)272-0837 .Llc. No.: 965837 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' compens tion, as provided for by Section 3700 of the Labor Code, for the performance oft rk for which this permit is issued. . I have and will maintain workers' compensation insurance, as required by Section 3 00 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: ACE AMERICAN INSURANCE COMPANY Policy Number: 064397114 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 l should become subject to the workers' compensation provisions of Section 3700 of the Lab= Code, I shall forthwith comply w'11(3 h those provisions. Date: Applican I K:S- WARNING: FAILURE TO SECURE WORKE PENSATION 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 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 o is c to enter the above- 's jproperty for inspection purposes. Date: `` Signature (Applicant or Agent): • Date: 3/13/2018 Application Number:. BELC2018-0034. Owner: PropertV*Jdress-.- '5,5,1105 AVENIDAMENDOZA DAVID QUESENBERG APN: 773073009 51105 AVENIDA MENDOZA Application Description: QUESENBERG / PANEL CHANGEOUT SAME SIZE AND LOCATION LA QUINTA, CA 92253 Property Zoning: Application Valuation: $4,000.00 Applicant: Contractor: JOSEPH TROMBINO JOSEPH TROMBINO 38801 NELSON -ROAD 38801 NELSON ROAD RANCHO MIRAGE, CA 92270 RANCHO MIRAGE, CA 92270 (760)272-0837 - Llc. No.: 965837 ------------------------------------------------------------------------ Detail: REMOVE AND REPLACE EXISITNG 200 AMP PANEL(SAME SIZE AND SAME LOCATION). THIS PER DOES NOTdNCLUDE ANY OTHER ELECTRICAL WORK. PER 2016 CALIFORNIA ELECTRICAL CODE. FINANCIAL INFORMATION DESCRIPTION -ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 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 ELE•:TRICAL: $39.01 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83 Total Paid for PERMIT IS:iUANCE: $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: $5.00 r 4v rza-- --.-- ----- PERMIT#Q�LC. -G1C�S PLAN LOCATION: Project Address: -r ib t Project Description: Pool, Remodel, Add't, Elect, Plumb,•Mech APN #: Telephone: Patio/Porch SF Email: Applicant Name: State Lic:q 3 City Bus Lic: Address: 'v State Lic: City Bus Lic: City, ST, Zip: Telephone: s Lv - Email:" 13 h ! Valuation of Project $ Contractor Name:. �� i New SFD Construction: Address: W VIWWJ� 4 Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic:q 3 City Bus Lic: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip City, ST, Zip Telephoner Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name: wv New Commercial / Tenant Improvements: Address: Total Building SF City, ST, Zip Construction Type: Occupancy: Telephone: .- Email: 49 U 9 78495 CALLE TAMPICO LA QUI NTA, CA 92253 760-777-7000 4 yi OFFICE USE ONLY # Sub mittal�. Req'd •Rec'd Plan Sets Structural Calcs it r Truss Calcs -` �; t ,, ► .� ` 1 , Title 24 Calcs r Soils Report S' Grading Plan (PM 10) r ` l r � Landscape Plan , 4 . f Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan . Planning approval Public Works approval Fire approval City Business License it 4 S . r. • S' F'r f�- r r �