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09-0078 (ELEC)- P, 0. BOX 1504 78-495 CALL -E TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-,00000078 Property. Address: 517.8'2 GAVENIDA OBREGON APN:, . 773-164-002-2 -000000- Application description: ELECTRICAL - Property Zoning: COVE RESIDENTIAL Application valuation: 800 Applicant: Architect or. Engineer: • V - J'A BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ­ Owner: NACHO GONZALES. 51782.AVENIDA OBREGON LA QUINTA, CA 92253 Contractor: HARTMAN ELECTRIC, GREG` .PO EOX 1427 -LA,QUINTA, CA 92247 (760)831-0664 Lic. No.: 898575 VOICE (760) 777-7012 FAX (760),777-7011 ,T1 1777-7153 LICENSED CONTRACTOR'S DECLARATION .. Date: ,02/09 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that.) am licensed under,proyisions.of Chapter -9 (commencing with. O Z'p O, . , y Al G O 4w�4 .._ LICENSED CONTRACTOR'S DECLARATION .. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that.) am licensed under,proyisions.of Chapter -9 (commencing with. I hereby affirm under penalty of perjury,one. of the followingdeclarations:- Section 7000) of Division 3 of the Business• nd Professionals Code; and my License is in full force and.effect. I have aridwill maintain a certificate of consent to self -insure for workerscompensation, as•provided " License Class: CIO License No.: 898575 _ forby. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate' ontractor: 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 OWNER -BUILDER DECLARATION - •• insurance carrier and policy number are: I hereby affirm under penalty -of perjury that I am exempt from the Contractor's'State License Law for the Carrier EXEMPT- - Policy Number EXEMPT following reason (Seca 7031.5, Business and Professions Code: Any city or"county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, -demolish, or repair any, structure,: prior to its issuance, alsoarequire's-the applicant for the person in any manner so as,to become subject to the workers' compensation laws of California, permit to file a signed'statementthat he or she is licensed pursuant to the provisions of -the Contractor's"State _ and agree that, if I. should bcome-subject to the ovorkers'-compensation provisions of Section License Law (Chapter 6 (commencing with Section 7000) of Division Sof the Business and Professions Code) or;. 3700 of the'L bor C =. Hall forthwi c hose provisions. - 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 (55001..: te: � � � plicant: 1 _ 1 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 offeredfor sale -(Sec. 7044; Business and Professions Code: The - WARNING: FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law.does.not apply owner of property who,builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND - ,toan and who does the work himself or herself through his or her. own emee ploys,. provided that the DOLLARS (sioo,000). 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 - impiove for the purpose of sale J. - 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 Director of Building and Safety for a permit subject to the 7044, 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(s) 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 performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec., , B.&P.C. for this reason the owner, and theapplicant, 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 theworkbeing performed under orfollowing issuance 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 correct. 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 onstiuction, a d her by authorize representatives " of this county to enter upon the above-mentioned propert f inspectio s _. --� Lender's Name: •�•7 � D e: (/_ 5 nature (Applicant or Agentl: Lender's Address: - LQPERMIT Application Number . . . . . 09-00000078 Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/.01/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE METER -SOCKET ON PANEL ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total ---------- 33.50 -------------------- .00 .00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 34.50 .00 .00 34.50 LQPERMIT Bin # . City of La Quin'ta Building U Safety Division P.O. Box :1504,, 78-495,... Calle Tampico La Quinta, CA92253 - (760) 777-7012 Building Permit Application -and Tracking Sheet Permit #n�y C i.. \) J` Project Address:~ Owner's Nae:. 60 ),J -zA I ES A. P. Number: Address: S 1 7$ -2 a6 i2 -f,- Czt 811 Legal Description: Contractor: G M G 9A-f-2�-1/Y A A) F M i cam+ . City, ST, Zip: Telephone: Address: `778 -IZI?_D Project Description: S Petr t -CE C.R- the City, ST, Zip: c.� Telephone: © 23L 666 City Lic. #: JD532fl State Lic. #: C:.. l� ` . �.g.675 Arch., Engr., Designer:^ . Address: City, ST, Zip: Telephone: :'Construction Type: s t- (C)w Occupancy: State Lic. #: Project type (circle one): New Add'n AlterRepair Demo Sq. Ft.: # Stories: l # Units: Name of Contact Person: Telephone # of Contact Person: Estimated Value of Project:<FlQQ , ©C) APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd .. Recd- - TRACKING PERMIT FEES Plan Sets Plan.Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. w.Called Contact Person Plan Check Balance Energy Calcs.. Plans picked up Construction Flood plain -plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsfissue Electrical Subcontactor List Called.Contact.Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '°" Iieview,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees