BELC2019-004178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
ELECTRICAL/
BELC2019-0041
77753 AVENIDA MONTEZUMA
773074002
AT&T WIRELESS / 200A TEMPORARY CONSTRUCTION POWER
$2,500.00
Applicant: n
S R BRAY LLC DBA POWER PLUS u
1210 N RED GUM STREET
ANAHEIM, CA 92806
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APR 0 9 2019
CITY OF LAQUINTA
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 7000) of Division 3 of the Business and Professions Code;
and my License is in full force and effect.
License Class: B. C10, DD31 License N:��
Date: L/ 9- / / 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 contractors) 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/4/2019
Owner:
COACHELLA VALLEY RECREATION
75841 CLINTON ST
INDIO, CA 92253
Contractor:
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
(714)507-1881
Llc. No.: 980589
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 t71 -n-3700
rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Secof 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: FEDERAL INSURANCE COMPANY Policy Number: 54309652
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 fort with
comply with those provisions.
Date: / _t -7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM EN5ATION 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: / Signature (Applicant or Agent):
Application Number:
BELC2019-0041
Property Address:
77753 AVENIDA MONTEZUMA
APN:
773074002
Application Description:
AT&T WIRELESS / 200A TEMPORARY CONSTRUCTION POWER
Property Zoning:
Application Valuation:
$2,500.00
Applicant:
S R BRAY LLC DBA POWER
PLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
Owner:
COACHELLA VALLEY RECREATION
75841 CLINTON ST
INDIO, CA 92253
Contractor:
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
(714)507-1883.
Llc. Na.: 980589
Date:,,.. 414/2019
Detail: INSTALLATION OF ONE 200AMP OVERHEAD TEMP METER TO PROVIDE TtMPORARY'OOWER SERVICE FOR CELL TOWER CONSTRUCTION ONLY, TO
FOLLOW ENCROACHMENT PERMIT ENC2019-0034. PER 2016 CALIFORNIA'BUILDING CODES.
FINANCIAL ,1•
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$18.68
Total Paid for ELECTRICAL: $45.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404:d
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
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
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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Project Address: -7 f�- tfj„ ,o
APN #:
PERMIT # 7)6�-C,2o I� - OCY4
PLAN LOCATION:
MOZ Project Description:
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Applicant Name:
Address: t�(p ��, AV, we c el
City, ST, Zip:1�hfivt fZ
Telephone:/-ZJ 7
Email:Valuation of Pro 9 Ov
Q tom., U� DO W.�- Irl ��r . r n.� Project i �
Architect/ Engineer Name: Construction Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: �v PA- H New Commercial / Tenant Improvements:
Address: '1er 1Q Total Building SF
City, ST, Zip o� u,ZSR Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittji Required Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
CVWD Fire Flow Letter
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
:LC:ityBusiness License
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BUILDING DIVISION
REVIEWED FOR
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CODE
DATE � � By
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