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BELC2018-009478-495 CALLE TAMPICO T4Aa / D w4z� Qk4t'L VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Permit Type/Subtype: ELECTRICAL/ Owner: Application Number: BELC2018-0094 KEGUN BREN Property Address: 77330 CALLE COLIMA 77330 CALLE COLIMA APN: 774072011 LA QUINTA, CA 92253 Application Description: MOHR / 100A ELECTRICAL SERVICE CHANGE OUT Property Zoning: Application Valuation: $1,450.00 Applicant: Contractor: MOHR ELECTRIC D QMOHR ELECTRIC 74000 DINAH SHORE DR # 413 74000 DINAH SHORE DR # 413 PALM DESERT, CA 92211 �C I 0 2U18 PALM DESERT, CA 92211 vD (760)770-8866 CITY OF LAQUINTA Llc. No.: 604990 DESIGN & DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: ClQ License No.: 6604990 Date: 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).: (_) 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.). (_) 1, 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: Date: 10/1/2018 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 Cade, for the performance of tor which this permit is fssued. 0have 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: HARTFORD INSURANCE COMPANY OF THE MIDWEST Policy Number: 1 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 Lab I shall forthwith comply with thos pr isions. Date: Applicant: r 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. CONSTRUCTION LENDING AGENCY I 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 ordinances a&Irelabuilding the performance ofthe work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of te above -mention dproperty for inspection purposes. Lender's Name:Date: l Signature (Applicant or Agent Lender's Address: Date: 10/1/2018 Application Number: BELC2018-0094 Owner: Property Address: 77330 CALLE COLIMA KEGUN BREN APN: 774072011 77330 CALLE COLIMA Application Description: MOHR / 100A ELECTRICAL SERVICE CHANGE OUT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,450.00 Applicant: Contractor: MOHR ELECTRIC MOHR ELECTRIC 74000 DINAH SHORE DR # 413 74000 DINAH SHORE DR # 413 PALM DESERT, CA 92211 PALM DESERT, CA 92211 (760)770-8866 Llc, No.: 604990 -----------•-_--•-------------------------- ------------ T ------------------------------------ Detail: 100A ELECTRICAL SERVICE CHANGE OUT [100A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA BUILDING CODES. i DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 1 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT SERVICES 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT CITY AMOUNT SERVICES PC 101-0000-42600 0 $13.00 Total Paid for ELECTRICAL: $39.01 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: $98.83 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 PERMIT # %eLt2.o� ~ o PLAN LOCATION: Project Address: n� n w 1 Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: ve- i + d0 A Applicant Name: �� G Address: I )10- `� Y City, ST, Zip: &'MAc-s<!r-t� Telephone: Q - Z 0- 3& Email: Valuation of Project S Contractor Name: I `O k41e,- GLazInfiL New SFD Construction: Address: 7If0o0 NAl-1 s lrfb�,G -b Conditioned Space SF City, St, Zip �LtK �., y L4 4 ZZ Garage SF Telephone: �p -7 ,7 0 _ ��� Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lic: 0 O 61 ( Z Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name: K CU U to New Commercial / Tenant Improvements: Address: 330 Cde Cold a Total Building SF City, ST, Zip L Q g 22-5'3 Construction Type: Occupancy: Telephone: Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Rec'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License 1 Bren Kegun E I Morrell Janel J 77330 Calle Colima La Quinta, CA 92-253 Riverside County APN: 774-072-011 Built: 1980 Type: Residential / SFR Beds: 3 Sq Ft: 1,258 Baths: 2 Order Gus#onier Service CoslsFirst" Add to Farm List Report Name Actions Combined Report Edit I Run Property Profile Run Available Allowance 97 100 Transaction History Run 99 100 V