BELC2019-006878-495 CALLE TAMPICO
"`..Y'T V'�Qu&m
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/
Application Number: BELC2019-0068
Property Address: 79513 HIGHWAY 111
APN: 600020009
Application Description: CHEVRON EXTRA MILE/ EV CHARGING STATION
Property Zoning:
Application Valuation: $40,000.00
Applicant: D
ANDREW VALENZUELA /VIDEO VOICE DATA COMM ICA ONS
12681 PALA DR OCT 2 2 2019
GARDEN GROVE, CA 92841
CITY OF LA QUINTA
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: C•7. C10. B. A License No_ 821598
Date: fl 7_2 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
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/22/2019
Owner:
G&MOIL CO
16868 A ST
HUNTINGTON BEACH, CA 92253
Contractor:
VIDEO VOICE DATA COMMUNICATIONS
12681 PALA DR
GARDEN GROVE, CA 92841
(714)897-6300
Llc. No.: 821598
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.
�+fI 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: OLD REPUBLIC 1INISURANCE CQB—PQ.RATIONPolicy Number:
AlCW12781
_ 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: 104, Applicant:
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;_ Signature (Applicant or Agent):
Date:
10/22/2019
Application Number:
BELC2019-0068
Property Address:
79513 HIGHWAY 111
APN:
600020009
Application Description:
CHEVRON EXTRA MILE/ EV CHARGING STATION
Property Zoning:
Application Valuation:
$40,000.00
Applicant:
ANDREW VALENZUELA /VIDEO VOICE DATA COMMUNICATIONS
12681 PALA DR
GARDEN GROVE, CA 92841
Owner:
G&MOIL CO
16868 A ST
HUNTINGTON BEACH, CA 92253
Contractor:
VIDEO VOICE DATA COMMUNICATIONS
12681 PALA DR
GARDEN GROVE, CA 92841
(714)897-6300
Llc. No.: 821598
Detail: CHEVRON / ELECTRICAL VEHICLE CHARGING STATION AT EXISTING PARKING AREA + 75kV TRANSFORMER TO SUPPLY EQUIPMENT. 2016
CALIFORNIA BUILDING & ELECTRICAL CODES.
INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
APPLIANCES, NON-RES
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
APPLIANCES, NON-RES PC
101-0000-42600
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
POWER APPARATUS
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $160.08
DESCRIPTION
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
TOTALS*4:
tea QU i�r
PERMIT # a ELC1210 19- Gv4?
PLAN LOCATION:
Project Address:
79513 Hiwa 111 Lauinta 92253
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Installation of 1 EV charging station
Applicant Name:AAJd0'QW�L,
I��Z��Video
Voice- Data Communications
Address:
12681 Pala Drive
City, ST, Zip:
Garden Grove Ca. 92841
Telephone:
562-572-5633
Email: wdmana ement wdcomm.net
Valuation of Project $ 40,000
Contractor Name:
New SFD Construction:
Address:
Conditioned Space SF
City, St, Zip Garden Grove Ca. 92841
Garage SF
Telephone: 562-572-5633
Patio/Porch SF
Email:
v►rdman ement wdcomm.net
Fire Sprinklers SF
-
State Lic: 821598 City Bus Lic: Pending
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: G&M Oil
New Commercial / Tenant Improvements:
Address: 79513 Highway 111
Total Building SF
City, ST, Zip La Quinta, Ca. 92253
Construction Type: Occupancy:
Telephone: 714-475-6379
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
T-Vf 44a"
DESIGN & DEVELOPMENT DEPARTMENT
78-495 CALLE TAMPICO ❑
LA QUINTA, CALIFORNIA 92253
(760) 777-7125 FAX (760) 777-7011 W
PATH OF TRAVEL UPGRADE DETERMINATION
W
DATE: 8 6 19 ADDRESS: 79-513 Highwav, 111 0
STATUS: DESCRIPTION: EV CHARGING ST
PLAN CHECKED BY: _ APPLICANT:
TELEPHONE NUMBER:
PLAN CHECK #: BELC2019-0068
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In accordance with the 2016 California Building Code (CBC) Section 1113-202.4, exception 8, the cost of compliance with
Section 110-202.4 is allowed to be limited to 20% of the adjusted construction cost of the alterations, structural repairs
or additions when the adjusted construction cost does not exceed the current valuation threshold.
Construction cost for proposed project (not including costs of improvements to the path of travel to the area of
alteration): $ 32,000 (A)
Cost of alterations to areas on this path of travel undertaken during the preceding three-year period which did not
provide an accessible path of travel to the area of alteration (as applicable): $ 8,000 (B)
Adjusted construction cost (C) = (A) + (B) $ 40,00a (C)
TH OF TRAVEL CONSTRUCTION COSTS:
�A
Elements serving the area of alteration
based on priority
Is element in If not, will element be Proposed cost of
compliance with upgraded to current compliance with
current Chapter Chapter 116? (Y/N) current
11B?(Y/N) Chapter11B
1. An accessible entrance
Y
Y
Y
$
2. An accessible route (interior and
exterior) to the
_altered area
$
$
$
3. At least one accessible restroom for
each gender or a single accessible unisex,
single user or family restroom
4. Accessible public telephones
N/A
5. Accessible drinking fountains
6. When possible, additional accessible
elements such as:
N/A
$
a. Parking
N
Y
$7,500
b. Storage
$
c. Signs
N
Y
$500
d. Alarms
$
e. Other
$
Total cost of providing compliant path of
travel elements: I
$8000
(D)
COST OF PATH OF TRAVEL UPGRADES AS PERCENTAGE OF ADJUSTED CONSTRUCTION COST:
Compliance of path of travel upgrades as % of adjusted construction cost: (E)% = 1 20% (E)
(D) / (C)
Note: This may not be less than 20%
Page 1 of 2 Io
VV0LTAIC
A OIV I5101.1 01
VIDEO VOICE DATA Com n u111—Ons
Letter of Authorization to Obtain a Permit
PURPOSE: All applications for permits must be submitted to the City of La Quinta for review and
approved prior to permit issuance. The purpose of this form is to authorize a Video Voice Data
Communications (VVD) employee(s) declared below to obtain permits on behalf of the owner,
Ban Montoya. By authorizing this letter, the owner fully understands complete ordinance
Compliance is the ultimate responsibility of the owner.
Submitted to: The City of La Quinta
Date: 05/30/19
To Whom It May Concern:
I, Ban Montoya, as the owner of Video Voice Data Communications, 12681 Pala Drive, Garden Grove CA
92841, do authorize the following person(s) to act on my behalf to sign and obtain a permit application/or
business license for the above mentioned business on my behalf.
This authorization shall remain in full force and effect for one year from the date of signature and/or until
the above divisions are notified in writing that such authorization is canceled or amended by this
contractor.
NAME (PRINT)
NAME (PRINT)
NAME (PRINT)
Sincerely,
Ban Montoya I President
License #821598
VVOLTAIC
rnwei�ni n�
Vince Vim,— D— Co��Mi�niG.,nane
Letter of Authorization to Obtain a Permit
PURPOSE: All applications for permits must be submitted to the City of La Quinta for review and
approved prior to permit issuance. The purpose of this form is to authorize a Video Voice Data
Communications (VVD) employee(s) declared below to obtain permits on behalf of the owner,
Ban Montoya. By authorizing this letter, the owner fully understands complete ordinance
compliance is the ultimate responsibility of the owner.
Submitted to: City of La Quinta
Date: June 12, 2019
To Whom It May Concern:
I.A�f-C as the owner of Video Voice Data Communications, 12681 Pala Drive,
Garden Grove CA 92841, do authorize the following person(s) to act on my behalf to sign and obtain a
permit application/or business license for the above mentioned business on my behalf.
This authorization shall remain in full force and effect for one year from the date of signature and/or until
the above divisions are notified in writing that such authorization is canceled or amended by this
contractor.
NAME (PRINT)
NAME (PRINT)
NAME (PRINT)
Sincerely,
Ban Montoya I President
License #821598
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California
County of OPAO�61E-
on �ur�_i z, �)� - before me, _� `�:✓��G Iv°`�4'?` f
Or• Inge Reno 6novil, IL9i
personally appeared AaToF>rl �-u 6P't h]"[ t� M�t��o`�f't -- .,
who proved to me on the basis of satisfactory evidence to be the person(s}whose
name(&) is/afe subscribed to the within instrument and acknowledged to me that
he/shot## try executed the same in his/her4theif authorized capacity(+es), and that by
hisilhefAheif-signature() on the instrument the person*, or the entity upon behalf of
which the personM acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
JIMMY WONG
W11'NESS my hand and official seal. Commission No. 2253974
NWARV etc-CALWORN[LA
ORANGE COLNM
' � My Contras Erpirq kt)WEltNER Yt, 217Q�
Notary f'ubl Ig At v Public Seal)
At�E71T10NA OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This farm complies with current California stalutes regarding notary wording and.
DESCRIPTION OIAHE ATTACHED DOCUMENT
iJ'needed, should be completed and attached to the document. Acknowledgments
from other states may be completed for documents being sent to that state so long
VVLIA t c 7✓tt>, F �� Rl`t1
as the wording does not require the California notary to violate California notrny
r(ny.
(Title or description of attached document)
State and County information must be the State and County where the document
—Vo oglftj A' }'fit
signers) personally appeared before the notary public for acknowledgment,
of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
must
(Title or description of attached document continued)
Number of Pages Document Date
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public),
• Print the name(s) of document signer(s) who personally appear at the time of
CAPACITY CLAIMED BY THE SIGNER
Individual (s)
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
helshe/they—, is/are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
❑ Corporate Officer
• The notary seal impression must be clear and photographically reproducible.
Impicoion must not Cover text or Imes. If seal Impression smudges, re -seal if a
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
suMeient area permits. otherwise complete a different acknowledgment form.
Signature of the notary public must match the signature on file with the otlice of the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date
Indicate the capacity claimed by the signer, If the claimed capacity is a
corporate officer, indicate the title (i.e CEO, CFO, Secretary).
2015 Version www. NolaryClasses. Corr, 80&,8 r 3-9865 • Securely attach this document to the signed document with a staple.
comdev
From: Lauren Roberts <Iroberts@gmoc.com>
Sent: Tuesday, April 23, 2019 3:22 PM
To: Son Tran
Cc: Jezer Lopez; Carlos Villegas; Brendan ODonnell
Subject: RE: G&M Next Steps
Attachments: 2994_001.pdf
Hello Son,
Attached are PDFs of some of the Phase 2 sites. I have made a few notes below on the spreadsheet. I am putting #62
(Fontana), #5 (Fullerton), #16(Whittier) at the bottom of the list — those we need to wait. #121 (Riverside) is to be
removed from list because we will soon not operate that site.
#27(Victorville) I did include a Site Plan for because there are SO many parking spots and it might be easy. I just have to
find out which spaces on the south side we reserve for the QSR tenant. If you want to put it in a completely different
spot then I won't worry about it.
Let me know if you have any questions on any of the sites. Thanks. I will work on getting the AutoCAD files as well.
ItL I W I."
ChevronEM
83
120
827GR
500 South Aztlsa Ave.IGladstone Street
ChevronEM
143
83-914
4991 Lang Beach Blvd./W. Del Arno Blvd_
ChevronEM
187
83-914A
17055 Lakewood Blvd./Park St.
ChevronEM
183
83-913J
18501 Beach Blvd./Main St.
ChevronEM
184
83-915A
6600 N. Indian Canyon Drive/Garnet Ave.
ChevronEM
146
83-915
79513 Highway 111/Dune Palms Rd.
ChevronEM
28900 Rancho California Rd/Jefferson
181
83-915J
Ave.
ChevronEM
76
83-915C
4095 N. University Pkwy/1-215 Fwy,
ChevronEM
102
83-915B
4304 E. Highland Ave./Boulder Ave.
ChevronEM
62
83-915D
14454 Foothill Blvd./Cypress Ave.
ChevronEM
27
—1
I 83-9151
14250 Bear Valley Road/Mall Blvd.
ChevronEM
1201 E. Orangethorpe Ave./Raymond
5
83-913B
Ave.
G&M
12559 Lambert RdJSanta Fe Springs
16
83-914D
Rd.
ChevronEM 121 83-915F 9267 Jurupa� Ave./Crest Ave.
From: Son Tran <son.tran@vvdcomm.net>
Sent: Monday, April 22, 2019 2:51 PM
Azusa
Los Angeles
Long Beach
Los Angeles
Bellflower
Los Angeles
Huntington
Beach
Orange
Palm Springs _
Riverside
La Quinta
Riverside
Temecula
Riverside
San
San Bernardino
Bernardino
San
Highland
Bernardino
San
Fontana
Bernardino
San
Victorville
Bernardino
Fullerton Orange
Whittier Los Angeles
Riverside Riverside
1
To: Lauren Roberts <1robe rts@gmoc.com>
Cc: Jezer Lopez <jezer.lopez@vvdcom m. net>; Carlos Villegas <cvillegas@vvdcomm.net>; Brendan ODonnell
<brendan.odonnell@chargepoint.com>
Subject: RE: G&M Next Steps
Well lets start off with PDF then, and if CAD comes in a few days that would be great. Until then, we will trace what we
can.
-v'd 41, 12 iiIA
VOLTAIC
�rtsa�anei
From: Lauren Roberts <Iroberts@gmoc.com>
Sent: Monday, April 22, 2019 2:08 PM
To: Son Tran <son.tran@vvdcomm.net>
Cc: Jezer Lopez <iezer.lopez@vvdcomm.net>; Carlos Villegas <cville as vvdcomm.nei>; Brendan ODonnell
<b ren da n. odo n nel l @ cha rgepoint.co m>
Subject: RE: G&M Next Steps
Hi Son,
Do you need the AutoCAD File or is just a PDF File acceptable? The AutoCAD files might take me a few more days
because I have to get that from Travis & Company.
Thanks,
Lauren
From: Son Tran <son.tran@vvdcomm.net>
Sent: Monday, April 22, 2019 11:30 AM
To: Lauren Roberts <lroberts _gmoc.com>
Cc: Jezer Lopez <jezer.l,opez@yydcomm.nPt>; Carlos Villegas <cviilegas@vvdcomm.nei>; Brendan ODonnell
<bre nda n.odo iine I i @c h a rp,epo int. co m>
Subject: RE: G&M Next Steps
Hi Lauren,
I hope you had a great weekend. I wanted to follow up to see when you are able to get those site plans for the
additional sites.
Thanks!
'IkJ Ii 1 t 41-11 1 Electrical Engineering
Xl'OLTAIC
Video Voice Data Communications ; Voltaire I)Msion
11631 Seaboard Circle, Stanton, CA 90680
Office: (714) 334-3111 Mobile: (562) 572-56313 t
n ea. Er�n�:1►[�dr o ri1 it3. n e t
From: Son Tran
Sent: Thursday, April 18, 2019 7:51 PM
To: Brendan ODonnell <brendan.odonnell@chargepoint.corri>; Lauren Roberts <lroberts@gmoc.com>
Cc: Jezer Lopez < ez� - er.lo ez vvdcomm.net>; Carlos Villegas <cvilleg�as@vvdcor-nm.net>
Subject: RE: G&M Next Steps
Hello,
I wanted to provide everyone with an updated spreadsheet!
Thank you!
aid Y i � 8 ■�fi
'VOLTAIC
s an�tr<�11CMv4c9m-ni,ttF_.
From: Brendan ODonnell <brendan_.odonnell@chargepoint.com>
Sent: Tuesday, April 16, 2019 2:48 PM
To: Lauren Roberts <lroberts@gmoc,com>
Cc: Son Tran <son_tran(@vvdcomm.net>; Jezer Lopez <jez�_er.lopez@vvdcomm.net>
Subject: G&M Next Steps
Hi Lauren,
We went over the requirements and will try to upload all the docs for you (need to add us as collaborators).
Here are the next steps:
• VVD to update status on Excel by COB today. Brendan to review with Lauren tomorrow.
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All meet again Friday to review the submission process, as follows:
1. G&M Sign application forms (email sent with all of them by Brendan from Kevin separately)
a. G&M will upload signed Application Form
2. Using attached "SCIP add collaborator guide", G&M add as collaborator, and we can all
access this at https:Zlcalevip.org/dashboard with that login and password: g&m123456789.
a. VVD will upload Permits, Invoices & fill in all Install Data
b. ChargePoint will upload MSSA.
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C D
E F
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1SignedAppikatlonForm(perhapsChargaPoimhas tW
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2 Coplesal Pwmlts (all - be It electrical or building, etc(,
3 Also need the Date Clty/Caty Permits AppBed For
4 Date OtyXntyPermltsReceNed
5 Date Final Inspection Passed
6 Ut*ty Permits??— total tog and applied and retelved date
Dasign Invoice (must include contractorterameer name, contractor/engineer
konse number, business address, phorse number, Itomitad coats, and p vn*M
7 terms [I,e, paid in f4A —check}],
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Equipment Ptarchase Inrreice (must show purchase date, retailer name, business
address, phone number, equipment make and model, equipment serial number
8 and payment terms (Le. paid In lull —cheft
Installatlon Purchase Irwice (complete Invoice is executed and signed and must
Include contractor name, contractor license amber, buur+ess address, phone
9 number, itemized costs, and payment terms II_e. paid In lull check)]
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10NetworkAgreement (Brendan -I assume this Is our MSSA with ChargePdnt?) Yes,M55A
11 Final inspection Card WD 11VU
Screen shots below.
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