09-0914 (ELEC)4 e(P
TA
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/27/09
Application Number: 09— 000914 Owner:
. .
Property Address: 51490 AVENIDA OBREGON JEFF FREDERICKS
APN: 773-081-017-4 -000000- 51490 AVENIDA OBREGON
Application description: ELECTRICAL LA QUINTA, CA 92253 ,r
Property Zoning: COVE RESIDENTIAL.
Application valuation: 30 U U
Contractor:
Applicant: Architect or Engineer: F.REDERICKS JEFF R.
28 10TH COURT
HERMOSA BEACH, CA 90254 't`�`�' ' = �t>IZA
p1n (330)918-7548
Lic. No.: 514045 „
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I am licensed• under provisions of Chapter,9 (commencing with I hereby affirm under penalty of perjury one of the following, declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and my License•is in full force and effect: _ I have and"will maintain certificate of'consent'toself-insure for workers' compensation, as provided
. License Class: B- Licen' No.: 514045 for by Section 3700 of the Labor Code, for the, performance of -the work for which -this 'permit is
...issued.
:8-,,1,7— -a7 ntractor: - _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
f - Code, for the performance of the work for which this permitis issued.- My workers' compensation
O ER -BUILDER DECLARATION _ '- insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that -I a exempt from the Contractor's State LicenseLawfor the Carrier EXEMPT Policy Number: - EXEMPT - 1
following reason (Sec. 7031.5, BusinessandProfessions Code: Any city or county tharrequires a -permit to!.certify that, in the performance of the work.for which this permit is issued, -I shall not employ any .
construct, alter,' impi:ove,.demolish, orrepaivany structure, prior to its issuance, also requires the applicant. for the person in any mannerso'as to become'subject ib.the':workers' compensation laws of California,
permit to file a signed statement'that he ohshe is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subje t to workers'. compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 370'0/of the Labor Co e,.l s all forth c ply, with those provisions.
that he.or, slie'isezempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by aq_q,aa✓/ '
any applicant for a permit subjects the applicant to a•civil,penalty of not more than five hundred dollars ($500).: ate: / O� pplicant:
1, as owner of the property, or rimyemployees with wages as their sole compensation, will do the work, and.
the'structure isnot intended or,offered forsale•(Sec. 7.044, Business and Professions Code: The WARNING: FAILURE TO SEC W - KE OM PEN SATION.COVERAGE IS UNLAWFUL, AND,SHALL
-Contractors' State -License Lawdoes not 'apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIM NAL P ALTIES AND.CIVIL FINES UP TO ONE,HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provide dthat the - DOLLARS ($1,00,000)1 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
:improvements are not intended or offered for sale. If,•however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. ,
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.). APPLICANT ACKNOWLEDGEMENT
1 _ ) I,,as owner'of the. property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the lbirectoi.of,Buildirig and Safety for a permit subject fo the '
704:4, Business and Professions Code: The Contractors: State License Law does not apply to an owner of conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor(sl licensed. 1. Each person upon whose behalf this application is made, each person at whose request and for -
pursuant to the Contractors' State License Law.). - whose benefit work is performedunder, or pursuant to any permit issued as a result'of this application,
(_ 1 I am exempt under Sec. , BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or followingissuance of this permit.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is corre . I agree,to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.)• city and county ordinances and state laws relating to building const22.,
and'he y authorize representatives
of this c ty to enter upo a above-mentioned prop y inspurpo
Lender's Name:
ignature (Applicant or Agent!:
Lender's Address: `6U,,.)•
LQPERMIT
LQPERMIT
Application Number . . . . . 09-00000914
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 15.75 Plan Check Fee
3.94
Issue Date . . . . Valuation . . .
. 0
Expiration Date 2/23/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXT,URE 1ST 20
.75
Special..Notes and. ;Comments
REPLACE MAIN`BREAKER TAB.
---------------------------------------------
nr.
Other Fees BLDG.STDS_ADMIN_(SB1473)
1.00
° Fee .summary Charged Paid. Credited ,
Due::
Permit `Fee Total- 15.75'> .:00 0`0
15.75 "
.;.
Plan Check"`Total -3.94- .`00 ._00-
3_.94
Other Fee 'Total 1.'00 00 :00•
1.00.
Grand Total- 20.69 :00 0'0."
: . 20.69
LQPERMIT
U/
City of . La Q - - to
Building 8T Safety Pivhlon
P:O. Box 150.A:92253 - (760) 777-4, 78-495 Calle Tampico
La Qtiinta; C7012
Building Permit Application -and Tracking Sheet
'
Permit # "`�(
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�Pr°Jec� � ares. � �o
A. P. Number:
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�Oti nc Ntame:,
lRddress3"' f/<f�� i%s v!!/� -)M6 o��
Legal Description:
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CSTZip:
i .Contractor:
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Address:Pr"oD`es"%iption:
City, ST, Zip:
Telephone: ,?10-%/8�7I-fid
State Lie. 4: 5-/m City Lic. #: 6.9277
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic.
Name of Contact Person:
£"
ConstcuctiorrType: Occupancy:
; Pro ect'type circle one New Add'n Alter Repair
Demo
Sq. Ft: #Stories: #Units:
Telephone # of Contact Person:
-Estimated�Value of:Proj
APPLICANT: DO NOT WRITE: BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Reed
TRACING
Plan Check submitted
PERMIT FEES
Item
Amount
Structural Calcs.
Reviewed, ready:for.corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
plan Check Balance
Title 24 Calcs.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review; ready Cor correctionstissue
Electrical.
Subcontactor List
Called Contact Person '
Plumb(ng
Grant Deed
Plans picked no.
S.M.I.
H.0 A.•Approval
Plans resubmitted
Grading
IN HOUSE:-
7r° Review,.ready for co rrectionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total.Permit Fees