BELC2019-001878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
A'S CONTRACTOR INC
1095 N MAIN ST UNIT
ORANGE, CA 92867
ceit�v 4 �P Q"
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
ELECTRICAL- SERVICE CHANGEOUT/UPGRADE (WEB)/
BELC2019-0018
44185 CARMEN PL
604151001
CULLEN / PANEL UPGRADE 200 AMP
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JOHN CULLEN
)NTRACTORINC
N MAIN ST UNIT T
CITY OF LAQUINTA GRANGE, CA 92867
DESIGN & DEVELOPMENT DEPARTMENT
(800)886-1594
Llc. No.: 936193
P
QD
FEB 0 6 2019
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: B License No.: 936193
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.).
(_) 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 Name:
Lender's Add
Date: 2/6/2019
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 Code, for the performance
of Ih work for which this permit is issued.
1 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: STATE COMPENSATION INSURANCE, FUND Policy Number: 92289811
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: . ti 19-
cant:
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.
Date: Z i .5}Ire (Applicant or Age
Date: �/6/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
A'S CONTRACTOR INC
1095 N MAIN ST UNIT
ORANGE, CA 92867
BELC2019-0018
44185 CARMEN PL
604151001
CULLEN / PANEL UPGRADE 200 AMP
Detail: 200 AMP PANEL UPGRADE SAME LOCATION. PER 2016 CALIFORNIA BUILDING CODES
Owner:
JOHN CULLEN
Contractor:
A'S CONTRACTOR INC
1095 N MAIN ST UNIT T
ORANGE, CA 92867
(800)886-1594
Llc. No.: 936193
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
SERVICE CHANGEOUT/UPGRADE
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICE CHANGEOUT/UPGRADE PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $53.36
DESCRIPTION
ACCOUNT QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404 0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Project Address: Z//-/
APN #:
Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email:
Contractor Name:
Address: � i't1 � C
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City, St, Zip C cy� 2 �to
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Telephone: -1��� _-2 �}>.
Email: 4 `I
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State Lic: 3 g3 City Bus Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
City Bus Lic:
PERMIT #
RIMP
PLAN LOCATION:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
- Al A )�L Cz �-rc-J- c- 2 o G 4111-
Valuation of Project $ /000. oc
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction Type:
Grading:
Bedrooms: I Stories:
SF
SF
SF
SF
Occupancy:
# Units:
CLNew Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000