BELC2018-003378-495 CALLE TAMPICO D Xfv Q94a.
VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number:' BELC2018-0033 VINCENT VAN LE
Property Address: 78625 BRADFORD CIR
APN: 604225004 LA QUINTA, 92253
Application Description: VAN LE / PANEL.UPGRADE
Property Zoning:
Application Valuation:
Applicant: Contractor:
MENDOZA ELECTRIC MAR 12 2018 MENDOZA ELECTRIC
50-313 CALLE TOLOSA 50-313 CALLE TOLOSA
COACHELLA, CA 92236 CITY OF LA QUINTA COACHELLA, CA 92236
DESIGN AND DEVELOPMENT DEPARTMENT (760)404-7214
Llc. No.: 904511
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 ofthe Business and Professions Code, and
my License is in full force and effect.
License Class: C10 License No.:9045�11
.011110: 3A Z / `13 C~or: t ' A n-
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 ofthe Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 ofthe 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 ) 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 N
Lender's Address:
Date: 3/12/2018
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe 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 the war or which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 ofthe Labor Code, for the performance ofthe work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: CITIZENS INSURANCE COMPANY OFAMEMCA Policy Number:
WBX9583210
I certify that in the performance ofthe 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: ff Ap"M
WARNING: FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNi.AWfUL,--
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.
SlgMufe (Applicant or Agent): -t _!
Date: 3/12/2018
AppJjration Number: „ BELC2018-0033
'Prop"'AdldreSs--' " 78625 BRADFORD CIR
APN: 604225004
Application Description: VAN LE / PANEL UPGRADE
Property Zoning:
Application Valuation:
Applicant:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA,CA 92236
Owner:
VINCENT VAN LE
LA QUINTA, 92253
Contractor:
MENDOZA ELECTRIC
50-313 CALLE TOLOSA
COACHELLA, CA 92236
(760)404-7214
Llc. No.: 904511
Detail: 200A ELECTRICAL SERVICE CHANGE OUT [125A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA
BUILDING CODES.
-DESCRIPTION
INFORMATIONFINANCIAL
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
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
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PERMIT #
PLAN LOCATION:
Project Address:
7g rz�kCX jo I
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
C I C� e-
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A (V�
Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email.
Valuation of Project S�Z L)D CA-�---
Contractor Name: �J C)��'2� E (ec4r-; L
New SFD Construction:
Address: To
Conditioned Space SF
City, St, Zip ��21 C P .-
Garage SF
Telephone: -7(Qd _ -7,2 1 L f
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lie: City Bus Lie:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
F#Units:
Email:
State Lie: City Bus Lie:
Property Owner's Name: ►JC p J+ JAB L_C-
New Commercial / Tenant Improvements:
Address: 1, ` 5- `,- ALA o� o� C r
Total Building SF
City, ST, Zip
Construction Type; Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000