BELC2019-006278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
JOSEPH TROMBINO
38801 NELSON ROAD
RANCHO MIRAGE, CA 92270
ceitr4 4wQa4a
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
ELECTRICAL/
BELC2019-0062
78635 ALDEN CIR
604225025
GALUSHA / 200AMP ELECTRICAL PANEL CHANGEOUT
$2,500.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MITCHELL GALUSHA
78635 ALDEN CIRCLE
LA QUINTA, CA 92253
Contractor:
D JOSEPH TROMBINO
t�
38801 NELSON ROAD
MAY 2 £a 2019 D RANCHO MIRAGE, CA 92270
CIT(p ! ;1,C)IJI1111TA (760)272 0837
DESIkGN & D[-VLL0i1 ILNT DE R ilT il'J1[N i Llc. No.: 965837
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 Clas : License No.: 965837
Date: �V Contractor:
OWNER -BUILDER D LAR ION
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 Address:
Date: 5/28/2019
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 rk for which this permit is issued.
I 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: ACE AMERICAN 119SUPLANCE COMPANY Policy Number: C65200120
_ 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 of5ectio f the Labor I shall forthwith
comply wi 11thos �prrovisioons.
f Date: V� 0(
`Applicant:
WARNING: FAILURE TO SECURE WORK SATION 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 ate laws relating to building
construction, and hereby authorize representatives of is city enter upon the above-
mentionv r
rope y for inspection purposes.
Date: 1 Signature (Applicant or Agent):
k,
Date: 5/28/2019
Application Number:
BELC2019-0062
Property Address:
78635 ALDEN CIR
APN:
604225025
Application Description:
GALUSHA / 200AMP ELECTRICAL PANEL CHANGEOUT
Property Zoning:
Application Valuation:
$2,500.00
Applicant:
JOSEPH TROMBINO
38801 NELSON ROAD
RANCHO MIRAGE, CA 92270
Owner:
MITCHELL GALUSHA
78635 ALDEN CIRCLE
LA QUINTA, CA 92253
Contractor:
JOSEPH TROMBINO
38801 NELSON ROAD
RANCHO MIRAGE, CA 92270
(760)272-0837
Llc. No.: 965837
Detail: 200A ELECTRICAL SERVICE CHANGE OUT [125A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA
BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SERVICES
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SERVICES PC
101-0000-42600
0
$13.34
Total Paid for ELECTRICAL: $40.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
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
—f4' PERMIT # "�C2011 - OOC�Z
PLAN LOCATION:
Project Address: C,WProject Description:
APN #: iyc'
Applicant Name: W
IV
Address: kS
City, ST, Zip:
Telephone:
Email: A6t)
Contractor Name:
Add ress:
City, St, Zip
Telephone:
Email:
(41,
Valuation of Projects Salk
CC O� New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
State Lic: j �� City Bus Lic: p 11 C)-Ipg
SF
SF
SF
SF
Architect/Engineer Name: Construction Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email:
State Lic: City Bus Lic:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
11
OFFICE USE ONLY
# I Submittal I Required
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
Received