BELC2018-0022i
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t1t 4 4 Qu&&
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number: BELC2018-0022 WALTER SEAY
Property Address: 50980 CALLE OBISPO 58980 CALLE OBISPO
APN: 770104010 LA QUINTA,CA 92253
Application Description: SEAY RESIDENCE / PANEL CHANGE OUT -
Property Zoning:
Application Valuation: $2,000.00
Applicant: ®D 018 Contractor:
MENDOZA ELECTRIC ��D N ® MENDOZA ELECTRIC
SO -313 CALLE TOLOSA SO -313 CALLE TOLOSA
COACHELLA, CA 92236 C1N OF �GU�NSA COACHELLA, CA 92236
DESIGN AND DF�EI_OPE+ENj DEi'RR
(760)404-7214
Lic. No.: 904511
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: C30 License No.: 904511
Df ` Z0 vtontractor. 64%,
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.).
(_) 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 Nam
Lender's
Date: 2/20/2018
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:
Carrier: CITIZENS INSURANCE COMPANY OF AMERICA Policy Number:
WBX9583210
I certifythat 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 those provisions.
J
Date -'G- — 2-0 rgp'plicant: .-ev,
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 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: �-1_7 -1--Signature (Applicant or A(nt):
Date: 2/20/2018
Application Number:
BELC2018-0022
Owner:
Property Address:.
50980 CALLE OBISPO
WALTER SEAY
APN:
770104010
58980 CALLE OBISPO
Application Description:
SEAY RESIDENCE / PANEL CHANGE OUT
LA QUINTA, CA 92253
' Property Zoning:
Application Valuation:
$2,000.00
Applicant:
Contractor:
MENDOZA ELECTRIC
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
50-313 CALLE TOLOSA
COACHELLA, CA 92236
COACHELLA, CA 92236
(760)404-7214
--------------------------.-----------------------------------
Llc. No.: 904511
-------------------------------
Detail: REPLACE 200 AMP PANEL. PER 2016 CALIFORNIA BUILDING CODE
FINANCIAL •• •
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 ELECTRICAL: $39.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE: $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
S02-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
............ G EM �,frb 0T S.ERA. ........... _.....
PERMIT #
'
PLAN LOCATION:
Project Address: ®_ C) CAI1C D DSPC)
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
l
c?�3
4 J
n
Applicant Name: �•fQ &D .•z A ��' 4r
Email:
Address: Sc). --'3 13 CA tic -To
Email:
City, ST, Zip: CGLi.CkeLI 4 CA-- 9.q
Fire Sprinklers SF
Telephone: `%(oQ . y" DLi- -2")_ 1
Email:
Valuation of Project $ 7L►�ic.� ,(`��
. C.0 / -
Contractor Name:. dna z
Q
New SFD Construction:
Address: �� . 1 A 1 `
A
Conditioned Space SF
City, St, ZiipJ q
O
c?�3
Garage . SF.
Telephone: O _QL-A _ -7 a 1
Email:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: �� l City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: 1ll'Ai >?r St�G`
New Commercial / Tenant Improvements:
Address: D cs
Total Building SF
City, ST, ZipLA w �A A . CA-
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
#
Submittal
Req'd
Rec'd
'
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
M
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List '
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
•
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