BELC2017-0040M 'A
78-495 CALLE TAMPICO
T4ty, 4 e(P Qu&ro
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BELC2017-0040
Property Address:
53365 AVENIDA MENDOZA
APN:
774092018
Application Description:
SIEDERS / 100AMP PANEL UPGRADE TO 200AMP
Property Zoning:
Application Valuation:
$2,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JOE SIEDERS
53365 ACVENIDA MENDOZA
LA QUINT, CA 92253
Date: 4/26/2017
0000�0
Applicant: PDX Contractor:
VINTAGE E & S INC VINTAGE E & S INC
49950 JEFFERSON STREET 130-388 q 49950 JEFFERSON STREET 130-388
INDIO, CA 92201 APR 2 6 2017 INDIO, CA 92261
CITY OF QUINTA (760)775-0135
Llc. No.: 481352
DESIGN AND 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 Class- C10 C46 License No.: 481352
Dat Contractor.. t�
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).:
(1 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 I 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 Address:
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
ofta ork for which this permit is issued.
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: OLD REPUBLIC INSURANCE COMPANY Polity Number: 57WECZH7563
_ 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 I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with thos provisions.
Dater Applicant:✓ n 4 °LL4 t(
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 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,statethat 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 thiscity to enter upon th above-
mentioned property for inspection purposes.
Date:i, ' I Signature (Applicant or Agent):
t%/ f.
M ?
Date: '4/26/2017
Application Number:
BELC2017-0040
Owner:
Property Address:
53365 AVENIDA MENDOZA
JOE SIEDERS
APN:
774092018
53365 ACVENIDA MEN DOZA
Application Description:
SIEDERS / 100AMP PANEL UPGRADE TO 200AMP
LA QUINT, CA 92253
Property Zoning:
Application Valuation:
$2,000.00
Applicant:
Contractor:
VINTAGE E & S INC
VINTAGE E & S INC
49950 JEFFERSON STREET
130-388
49950 JEFFERSON STREET 130-388
INDIO, CA 92201
INDIO, CA 92201
(760)775-0135
--------------------------------------------------------------------------------------------
Llc. No.: 481352
Detail: 200A ELECTRICAL
UPGRADE[100A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA BUILDING CODES.
0
t
i
•• •
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
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
0
$12.67
Total Paid for ELE.: TRICAL: $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
1
i
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
r
Bin.# ,
Permit #i
Project Address- 3I05
City of La Quinta
Building a Safety Division -
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Owner's Name::) OC _ > i e tt V-
A. P. Number:
Address: S3 3 (As Ave_��Ag'_
Legal Description:
City, ST, Zip: u%
ntract
Co r:
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Telephone:
Add ress:�9stj
Project Description: � r ��—) YAC; n
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City, ST, Zip: ✓xgvcz1
Telephone:ne: 1' 1S
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1 3
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State Lie. # : ' �'a 3S�
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
an
truction Occupancy.
cYCo
n TYP e: S�
Lie.
Alter Repair. Demo
roet AddnPtype (circle one)! New
Name of Contact Person:
Sq. Ft.: SZW41O
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: "z
\
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs..
Called Contact Verson
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical ,
Subcontactor List
Called Contact Person
Plumbing
Gran(Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN 110USE:-
'"' Reyiew, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
r'
Total Permit Fees
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