BSPN2017-004778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/24/2017
Permit Type/Subtype: •
SPECIAL INSPECTION/
Owner:
Application Number:
BSPN2017-0047
TRISHA OSBORNE
Property Address:
80363 OAK TREE
80363 OAK TREE
APN:
775081080
LA QUINTA; C4 92253
Application Description:
OSBORNE / MAIN BREAKER
Property Zoning:
Application Valuation:
$250.00
Applicant: Contractor:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
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:, Y —Contw or.
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 o 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 ) 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 Name:
Lender's Address:
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 3;00 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' =ompensation 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: _ Policy Number: _
_ 1 certify that in the performance cf 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 Sectior 3700 of the Labor Code, I shall forthwith
comply with those provisions.
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 -he Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this app•ication 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 Cit} of La Quinta, its officers, agents, and
employees for any actor omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this applcation becomes null and void if work is not
commenced within 180 days from date of iss jance of such permit, or cessation of work
for 180 days will subject permit to cancellaticn.
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 ord nances 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: '�Z`�'�Z Signature(ApplicantorAgent:)
ti
Date: 10/24/2017
Application Number:
BSPN2017-0047
Owner:
Property Address:
80363 OAK TREE
TRISHA OSBOINE
APN:
775081080
80363 OAK TFEE
Application Description:
OSBORNE / MAIN BREAKER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$250.00
Applicant:
Contractor:
MENDOZA ELECTRIC
50-313 CALLE.TOLOSA
' COACHELLA, CA 92236
--------------------------------------------------------------------------------------------
Llc. No.:
Detail: REPLACE 100 AMP MAIN BREAKER IID REQUIRES SPECIAL INSPECTION.
METER HAS ALREADY BEEN PULLED. AS PER CEC 2016
DESCRIPTION
ACCOUNT QTY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: '
$78.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$S.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
JOTALS:
$S.00
$83.02
s
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Bin#
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City of La Quinta .
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
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Project Address:
-L e e
Owner's Name:
A.P. Number
Address:
Legal Description:
IAS i
City, ST, Zip:
Contractor:
1 i ; G
Telephone:
Address:Go'- l C
TO f O S
Project Description:
ODA M
City, ST, Zip:
l,�et
C A O12�
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Telephone: ( o —7z I Lf
State Lie. #:. o) 0 S
City Lie #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:
Occupancy:
State Lic. #:
Proj. Type New
Add'n
Alter
Repair
Demo
Name of Contact:
SgFt:
#Stories
# Units:
Telephone of Contact:
Estimated Value of Project:
7—
APPLICANT: DO NOT WRITE BELOW THIS LINE
APPLICANT:
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
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
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed ..
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees