BELC2017-0112Applicant: Contractor:
PROGRESSO ELECTRIC W PROGRESSO ELECTRIC
79140 KAYE CT lJ 79140 KAYE CT
LA QUINTA, CA 92253LA QUINTA, CA. 92253
DEC n
2 17
(760)343-8950
COMMUNITY DEIO OPMEEN DEPARTMENT Llc. No.::LIC OL05520
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.: :LIC -0105520
Dat ZI ) 1
Contract -
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 in 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:
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:
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
oft a rk for which this permit is issued.
e
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: _
_ I certify that in the performance oa 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 fiat, if I should become subject to the
workers' compensation provisions of Sectior 3700 of the Labor Code, I shall forthwith
comply with those provisions.
D e;k^Apacant: 1.[lVlif�a, LWY11 Awl'
WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,-)00). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKh:
Date: 12/21/2017
Application Number:
BELC2017-0112
Owner:
'Property Address:
60680 OROURKE CIR
DAN HILL
APN:
764330010
60680 OROUR:KE
Application Description:
HILL/ NEW LIGHTING IN KITCHEN AND LIVING ROOM
LA QUI.NTA, CA 92253
Property Zoning:
Application Valuation:
$500.00
Applicant:.
Contractor:
PROGRESSO ELECTRIC
PROGRESSO ELECTRIC
79140 KAYE CT
79140 KAYE Cif
LA QUINTA,•CA 92253
LA QUI,NTA, CA 92253
(760)343-8950
Llc. No.: :LIC -0105520 .
---,-----------------------7
- -------,----------------.------------------------------i-.---------
Detail: INSTALL [3] PENDANT LIGHTS IN KITCHEN. AND RELOCATE [4] CAN LIGHTS IN LIVI.NG
ROOM PER 2016 CALIFORNIA BUILDING CODES.
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
Credit Card Fee
101-0000-43505
0
$3.00
Total Paid for Credit Card Fee: $3.00
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:' $5.00
-
.................. GE N4 �,fiir T>i'_',SY.-.R:T' ._...............
PERMIT # GLC . 7 O f
-P-L-A—N:1- -CATIO- N'�
Project Addres :
0-62)0 Ofluke a otJ
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Conditioned Space
SF
City, St; Zip
�pplicant &me: " f G t4de 'L
Garage
Address:.
Telephone:
City, ST, Zip:
Patio/Porch
Telephone:
Email:
Email:
Valuation of Project $
Contractor Name:
Construction Type: Occupancy:
New SFD Construction:
Grading:
Address:
Construction Type: Occupancy:
Conditioned Space
SF
City, St; Zip
# Units:
Garage
SF
Telephone:
Patio/Porch
SF
Email:
Fire Sprinklers
SF
State LT
City Butes 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:
roperty O'er wne !s Name.�� t
New Commercial / Tenant Improvements:
Address: ,Ca srCJLJ
Total Building SF
City, ST, Zip i
Construction Type: Occupancy:
Telephoner
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
F
#
Submittal
Req'd
°Ree'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
I
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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FOR CCNS-TRUCTI.ON
FOR
DATE !Z Z 1 1. 17 BY �"5
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