BELC2019-005978-495 CALLE TAMPICO
L' 0 D e(P Quzkt
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/
Application Number: BELC2019-0059
Property Address: 51336 AVENIDA HERRERA
APN: 773085005
Application Description: ROBLES / ELECTRICAL ABOVE GROUND POOL
Property Zoning:
Application Valuation: ��
Applicant: n / ` y
LUIS GUSTAVO ROBLES V `-�
51336 AVENIDA HERRERA
LA QUINTA, 92253 MAY 10 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 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: &,ONV:14052810126R099659
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 far the alleged exemption. Anyviolatlon of Section 7031.5 by any applicant for a
pe rfiit s jects the applicant to a civil penalty of not more than five hundred dollars
-4, 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
a t Intended or offered for sale. If, however, the building or Improvement is sold
(thin a year of completion, the owner -builder will have the burden of proving that
not build or Improve for the purpose of sale.).
Kj I, as o nervf the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State Li nse Law does not apply to an owner of property who builds or improves
ere , and who contracts for the projects with a contractor(s) licensed pursuant to
raC 51State License Law.).
I am exempt under Sec. _ 8.&P.C. for this reason
r�
Tww A0 Qyilrw 4,-44
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
Lender's Ad
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/10/2019
Owner:
LUIS GUSTAVO ROBLES
51336 AVENIDA HERRERA
LA QUINTA, 92253
Contractor:
LUIS GUSTAVO ROBLES
51336 AVENIDA HERRERA
LA QUINTA, 92253
(760)583-2522
Llc. No.::CONV:140528101254099659
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 the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 f the Labor Code, for the performance of the work for which this permit
is issue y ,rkers' compensation insurance carrier and policy number are:
Car�emolov
umber:
an the performance of the work for which this permit is issued, I
sitrson 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 of the Labor Code, I shall forthwith
comply with hose provisions.
mate 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,
I certify that I have read this application and state that the ove information is correct.
I agree to comply with all city and county ordinances an sta a laws relating to building
construction, and hereby authorize representatives of t s cl to enter upon th
above -mend ned pr perty for inspection purposes.
art s
OBfe: ►+� ' SigrteWO (Applicant or Agent .
Date: 5/1' /2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
LUIS GUSTAVO ROBLES
51336 AVENIDA HERRERA
LA QUINTA, 92253
BELC2019-0059
51336 AVENIDA HERRERA
773085005
ROBLES / ELECTRICAL ABOVE GROUND POOL
Owner:
LUIS GUSTAVO ROBLES
51336 AVENIDA HERRERA
LA QUINTA, 92253
Contractor:
LUIS GUSTAVO ROBLES
51336 AVENIDA HERRERA
LA QUINTA, 92253
(760)583-2522
Llc. No.::CONV:140528101254099659
Detail: ELECTRICAL INSPECTION FOR GFCI FOR ABOVE GROUND POOL: MUNICIPAL AND QUILDING'CODES APPLIED TO POOL PLACEMENTTO BE FIELD
VERIFIED. PER 2016 CALIFORNIA BUILDING CODES.
FINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404 0
$101.40
Total Paid for PERMIT ISSUANCE:
$101.40
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 #
_Gc
Project Address:-
APN #:
Applicant Name:
Address: W 3 j
City, ST, Zip: I } _
Telephone; 7/j n
Emailk��S'1
t
vL8IN LUL81IUIV:
Project Description-,
(� v
`2-S_Z_
V4aluation of Project $
Architect/Engineer Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
Construction
Grading:
Bedrooms: � Stories:
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
I,
OFFICE USE ONLY
# I Submittal l Required ` Received
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
AU JCi( 4}-t 3 i -
CITY OF LA QUINTA
BUILDING & SAFETY DEPT
APPROVED
FOR CONSTRUCTION
DATE 6
_.
L. _