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