BELC2017-0102�
78-495 CALLS TAMPICO V �� VOICE (760) 777-7125
LA gUINrtA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/27/2017
Permit Type/Subtype: ELECTRICAL/Owner:
Application Number: BELC2017-0102 DORIS PALDEN
Property Address: 51965 AVENIDA OBREGON I�'•I ;'./ 7 201,% P 0 BOX 191
APN: 773163022 LA QUINTA, CA 92253
Application Description: CEILING FANS AND 3 RECESSE
Property Zoning:
Application Valuation: $2,600.00
Applicant: Contractor:
MENDOZA ELECTRIC MENDOZA ELECTRIC
50-313 CALLE TOLOSA 50-313 CALLE TOLOSA
COACHELLA, CA 92236 COACHELLA, CA92236
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: CIO License No.: 904511
411tOate:.1 (— 2 %' ( T 1Contractor:
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 aQ
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, on,
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.).
(_J 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:
(760)404-7214
Llc. No.: 904511.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one Y 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' -ompensation insurance, as required by
SeGgeo-34e&oftht-Labor Code, for the perfcrmance of the work for which this permit
Is Issued. My workers' compensation insurarce carrier and policy number are:
Carrier: CITIZENS INSURANCE COMPANY OF ,MERICA Policy Number:
I 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 t-iat, 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: X11 -Z%—i.,7 Applicant: 1( O10
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIM NAL PENALTIES AND CIVIL FINES UPTO
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 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 tl a 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 appication becomes null and void if work is
not commenced within 180 days from date cf issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and State that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county orlinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city to enter upon the -
above -mentioned property for inspection purposes.
Lender's Name:
MD te=til 7-1" J'1 Sign_t ce-(Applicacot or Agent):
Lender's Address:
Date: 11/27/2017
Application Number:
BELC2017-0102
Owner:
Property Address:
51965 AVENIDA OBREGON
DORIS PALDEN
APN:
-773163022
P 0 BOX 191
Application Description:
CEILING FANS AND 3 RECESSED LIGHTS
LA QUINTA, CA 92253
Property Zoning
Application Valuation:
$2,600.00
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: INSTALL POWER TO CEILING FANS AND RECESSED CAN LIGHTS AND REPLACE
3 LIGHTS ON EXISTING POWER: 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
DEVICES, FIRST.20
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.01
Total Paid for ELECTRICAL: $52.02
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
.502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE
Project Address: Dd re 0
PLAN LOCATION
Project Description: Pool,
I
Remodel, Add't, Elect, Plumb, IVIech
APN
Conditioned Space SF
A./ -f , 1"q-tl
Aa 'I -le" L/'Az�
Garage SF
—
Telephone:_
��ceSS a�
C.4/\/
Applicant Name:
�D eleG f- qr) '0 , l �o
�e ��iGe_
�r n/S N
Address:
City, ST, Zip:
Telephone:
Email:
Valuation of Project S
X00 Oy
Contractor Name: .7/I Elegy, •C
New SFD Construction:
Address:
� 7�D- /0 -j�q
Conditioned Space SF
amity, St, zip
?
69pGi G Ll e.b/ 4 0-4A �J 6�
Garage SF
—
Telephone:_
ln 4-1 _ %��L
Patio/Porch SF
Email:
�D eleG f- qr) '0 , l �o
Fire Sprinklers SF
State Lic:
�D City Bus Lic:
arch/trig Name:
Construction Type: Occupancy:
address:
Grading:
-ity, St, Zip
Construction Type: Occupancy:
.Fele.phone:
Bedrooms: 7Stor
mail:
4 Units:
avail:
;tate Lic: City Bus Lic:
'roperty Owner's Name:
New Commercial / Tenant Imlroy.ements:
,ddress:
Total Building - SF
'ity, ST, Zip
Construction Type: Occupancy:
elephone:
mail:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000