BELC2017-0111w ,-
78-495 CALLE.TAMPICO
LA QUINTA, CALIFORNI162253
Permit Type/Subtype: ELECTRICAL/
Application Number: BELC2017-0111
c&,w 4 4 Qu;,rw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address: 48760 SAN VINCENTE ST
APN: 646140031
Application Description: TOUSSON / 200 AMP PANEL CHANGEOUT W/ SAME '
Property Zoning:
Application Valuation: $1,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
T TOUSSOUN
P 0 BOX 1825
LA QUINTA, CA -92253
Applicant:Q Contractor:
COULTER ELECTRIC INC D ® COULTER ELECCRIC INC
78078 COUNTRY CLUB #202 78078 COUNTRY CLUB #202
BERMUDA DUNES, CA 92203 DEC 2 p 2017 BERMUDA DUNES, CA 92203
CITY OF LA QUINTA (760)660-2838
DESIGN AND DEVELOPMENT DEPARTMENT LIc. No.: 957021
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.:
957021
Date;: ^�CoI ntractor: _._.
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 li
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).:
L_J 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 Na
Lender's
Date: 12/20/2017
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one 2•f the following declarations:
I have and will maintain a certifica-,e 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.
UI have and will maintain workers' ompensation insurance, as required by
Section 3700 of the Labor Code, for the perfo-mance of the work for which this permit is
issued. My workers' compensation insurance carrier and polity number are:
Carrier: STATE COMPENSATION INSURANCE RUND Policy Number: 9150873
_ 1 certify that in the performance ofzhe work for which this permit is issued, I
shall not employ any person in any manner sc as to become subject to the workers'
compensation laws of California, and agree t&at, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, J shall forthwith
comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMNAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to t ie Building Official for a permit subject to
the conditions and restrictions set forth on th s application.
1. Each person upon whose behalf this appl cation is made, each person at whose
request and for whose benefit work is perforned under or pursuant to any permit issued
as a result of this application, the owner, andthe applicant, each agrees to, and shall
defend, indemnify and hold harmless the Cityof La Quinta, its officers, agents, and
employees for any act or omission related to 11he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appli-ation 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 ordnhances 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:- �� Signature (Applicant or -Agent):;
'
Date: 12/20/2017
Application Number: BELC2017-0111
Owner:
Property Address:48250 SAN VINCE•NTf"ST,: - _> -••
T TOUSSOUN
APN: 646140031
P 0. BOX 1825
Application Description: TOUSSON / 200 AMP PANELCHANGEOUT W/ SAME
LA QUI NTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
Applicant:
Contractor:
COULTER ELECTRIC INC
COULTER ELEC—RIC INC
78078 COUNTRY CLUB #202
78078 COUNTRY CLUB #202
BERMUDA DUNES, CA 92203
BERMUDA DUNES, CA 92203
(760)660-2838
Llc. No.: 957021
detail: 200AMP ELECTRICAL SERVICE CHANGE OUT [200A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA
BUILDING CODES.
DESCRIPTION
BSAS SB1473 FEE
DESCRIPTION
SERVICES
DESCRIPTION
SERVICES PC
DESCRIPTION
PERMIT ISSUANCE
DESCRIPTION
RECORDS MANAGEMENT FEE
ACCOUNT FQTY . AMOUNT
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA. $1.00-1
AMOUNT
ACCOUNT
QTY
AMOUNT
$5.00
101-0000-42403
0
$26.01
ACCOUNT
QTY
AMOUNT
101-0000-42600
0
$13.00
Total Paid for ELECTRICAL: $39.01
ACCOUNT
QTY
AMOUNT
101-0000-42404
0
$98.83
Total Paid Tor PERMIT ISSUANCE: $98.83
ACCOUNT
QTY
AMOUNT
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
Contractor Name:
PERMIT # PE D-157 1/—C/ � l
PLAN LOCATION:
Project Address:Project
`
Description: Pool, RemodeE, Add't, Elect, Plumb, Mech
APN #:
1
1pt 2
Bedrooms:
e�
Telephone:
Applicant Name: 2 �.
Patio/Porch . SF
Address: 4 D
- i�C r U
City, ST, Zip -
State Lic:
Telephone:
Email: c
rb
Valuation of Project
D�
Contractor Name:
w� L
New SFD Construction:
Address: �l
/�Z
Conditioned Space SF
City, St; Zip
Bedrooms:
-Garage SF
Telephone:
��
Patio/Porch . SF
Email:A l
- i�C r U
Fire Sprinklers SF
State Lic:
City Bus Lic:
W 7-
Arch/Eng Name:
Construction Type:.. Occupancy:
Address:
Grading: 4•
City, St, Zip
Construction Type: Occupancy:
Telephone: '
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address: 4? -7,% b sa 0- A t
Total Building SF l
City, ST,Zip t . 5
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000