BELC2017-010378-495 CALLE TAMPICO .
LA QU.INTA, CALIFORNIA 92253 t
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
JASON JULIANA
v� 4
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
ELECTRICAL/
BELC2017-0103
54120 AVENIDA VALLEJO
774213026
LEOTAUD / CAN LIGHT REPLACEMENT
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 -765380
Date: I 2 11 Contractor-
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).:
(� 1, 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.).
(� 1 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 f& which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
'Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/27/2017
Owner:
ROBERT LEOTAUD
1940 SOUTH GROVE
ONTARIO, CA 91761.
Contractor:
TOS DESIGN & CONSTRUCTION, INC.
OUTSIDE CITY LIMITS
(714)420-2515
Llc. No.::LIC-765380
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 thework for which this permit is issued.
J -) 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: _ 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.
Date: ) I 2� I Applicant:
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 anyact 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 isnot
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: I 1 21 )1 Signature (Applicant or Age Vt
Date: 11/27/2017
Application Number:
BELC2017-0103.
Owner:
Property Address:
54120 AVENIDA VALLEJO
ROBERT.LEOTAUD
_ APN:
774213026
1940 SOUTH (TROVE
Application Description:
LEOTAUD / CAN LIGHT REPLACEMENT
ONTARIO, CA 91761
Property Zoning:
. d
Application Valuation:
Applicant:
Contractor:
JASON JULIANA
TOS DESIGN &.CONSTRUCTION, INC.
OUTSIDE CITY -IMITS
(714)420-2515
LIc. No.::LIC-T5380
------------------------
Detail: REMOVE FLOURESCENT LIGHTS AND ADD 4 LED CAN LIGHTS. WITH DIMMER SWITCH.
I.
DESCRIPTION
ACCOUNT CITY AMOUNT
Credit Card Fee
101-0000-43505 0 $2.99
Total Paid for Credit Card Fee: $2.99
DESCRIPTION
ACCOUNT
CITY
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
CITY
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
F`'-
r� y
PERMIT# �CZQ�1 _O1C13
PLAN LOCATION
Project Address: S -I 20
Project Description: Pool,.Remodel, Add't, Elect, Plumb, Mech
APN4:
Garage _ SF
Telephone: 4 t 2'0 251m
Patio/Porch SF
Applicant Name:
Sprinklers SF
Address`. PO r3ox k001.4
City, ST, Zip: 101 baa C A . °!2 15
Telephone: '114 9 2 0;--2 Si s
Email:Valuation
6,V, f 544 Y* M 'A COcw\ el V'kA ►l. L -64 -
of Project S1 570
Contractor Name: QS C On l OnNew
SFD Construction:
Address: rSU(o S �,�� �}, �^ `� g
Conditioned Space SF
City, St, Zip Q l alCOA `A CA q 2 8-10
Garage _ SF
Telephone: 4 t 2'0 251m
Patio/Porch SF
Email:Fire
�J@ArS�iv��ht-�co►V�� Y�nc,��.Ce, '
Sprinklers SF
State Lic: • QO h0 3 City Bus Lic:
Arch/Eng Name:
Construction. Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephoner
Bedrooms:
Stories:
# Units:
Email:
State LIC:L City Bus Lic:
Property Owner's Name: �ZaberA e0 �A-0
New Commercial / Tenant Improvements:
Address: qy Q S rou AJ Q
Total Building SF
City, ST, Zip 0 A4 of , o CSA
Construction Type: Occupancy:
Telephone: `, 14 q
Email: b'o6@ (eek d iP .GO m
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000