BELC2017-004178-495 CALLE TAMPICO 4 VOICE (760) 777-7125FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/2/2017
Application Number: BELC2017-0041 Owner:
Property Address: 44575 PALA CIR MONICA PRESCOTT & JERRy.,RICE
APN: 604262006 44575 PALA CIR
Application Description: PRESCOTT & RICE RESIDENCE / ELECTRICAL LA QUINTA,PCTRIC
Property Zoning:
Application Valuation: $550.00
Applicant: Contractor:A�nVMENDOZA ELECTRIC MENDOZAk4 02. ?O„
50-313 CALLE TOLOSA 50-313 CALLE TOLOSA�+
COACHELLA, CA 92236 COACHEL�eg� 9 36C17*y0,0
tA
(760)404-7214 /VNQn,�LO��/NTA
Lic. No.: 904511-NTpEPgATMFNT
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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 License No.: 904511 i—
Dater Contractor:
WOOM I
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 thea,�
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
Lender's
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 thelabor 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 3100 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:
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 those provisions.
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.
Agent): �!�
:-4 'Z
Application Number: BELC2017-0041
Property Address:
44575 PALA CIR
APN:
604262006
Application Description:
PRESCOTT & RICE RESIDENCE / ELECTRICAL
Property Zoning:
Application Valuation:
$550.00
Applicant:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
Owner:
MONICA PRESCOTT & JERRY RICE
44575 PALA CIR
LA QUINTA, CA 92253
Contractor:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
Date: 5/2/2017
(760)404-7214
Llc. No.: 904511
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Detail: REPLACE MAIN BREAKER. PER 2016 CALIFORNIA BUILDING CODE
DESCRIPTION
ACCOUNT I .QTY I AMOUNT
BSAS SB1473 FEE 101-0000-20306 j 0 1 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS
101-.0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
POWER APPARATUS PC
101-0000-426000
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
PERMIT ISSUANCE
101-0000-42404
0
H$E96.27]
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
Permit ;l
Project Address: 5-7S-
6
City of La � UIn to
Building 8£ Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701.2
Building Permit Application and Tracking Sheet
PAI A C r Owner's Name: rno ,.) i CcZ Pf-eS GOT
A. P. Number:
Address: (PA (A
Legal Description: r'e-10'c-f— Mck" 6CCa k,.e
City, ST, Zip: L ,L Qom- e A
r ,ten � n
Cont act r- '
Contractor: 1 '' ` dtD 2 /�
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Telephone: Tele o e. - ,3 3 SS Y� U
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Address: 50 -3. t 3 C LL I, -To-to-SA
Project Description: la C-e. ty\cL
City, ST, Zip: C0A-C.k6kA
t:'4
TeleP hone: k.XA
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State Lic. # : q O Li S- L
City Lie. #t
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
hone:
an
Occupancy:
Construction Type: eY=
State Lc,.
i .#
New Add n Alter Repairai
Project (circle one); r Demo
p
Name of Contact Person: Ces A / UVle,�1 eQ� -z_
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: to 0`'104 -.-7 2- 1
Dstimated Value of Project:
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
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 Person
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
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'rd Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A; I.P.P.
Pub. Wks. Appr.
Date of permit issue
School Fees,
1
.
Total Permit Fees
Rl c:e