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13-0968 (ELEC)4 s(P P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT ;" J INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/02/13 Application Number: 13-00000968 Owner: Property Address: 52705 AVENIDA OBREGON BERGER TERJE APN: 773-284-023-10 -000000- *NOT ON FILE Application description: ELECTRICAL UNKNOWN, CA 99999 O Property Zoning: COVE RESIDENTIAL Application valuation: 600 Q Contractor: Applicant: Architect or Engineer: HEGGE ELECTRICAL CONT TRS C o 83852 AVENUE 45 01 q� NDIO; CA A92201 �' (760)775-48S5. LiC. No.: 748171 ------------------------------------------------------------------------------------------------- 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 a essional e, and my License is in full force and effect. License Clas : C10 cense No.: 748171 �\ Date Z Contractor `. OWNER- UILDER 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 (5500).: (_ 1 1, 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.). ' 1 1 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.I. Lender's Name: Lender's Address: VV LQPERMIT 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 �n1issued. \�1Il ave 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 BENCHMARK INS Policy Number CST5002276 1 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 beco o the workers' comp Sation laws of California, and agree that, if I should becom ubject to [he workers' compe tion, provisions of Section n r 3700 of 'the Labor Code, I shall rcomply with those pr isions, Date:, ' l_ Applicant: WARNING: FAILURE TO SECUCMINAL RS' OMPENSATION COVERAGE UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOCEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDE 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 Director of Building and Safety 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 Ouinta, 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 cor a t. I agree to co with all C and cou ordinances and state laws relating to buildin construction, and h eby authorize re entatives of this count to enter upon the above-mentioned pltroop\erty for pectiop,purpos 1 /' D to e: V' ignature (Applicant or Agent):\ \ //,/ LQPERMIT Application Number. . . . . . 13-00000968 Permit . . .. ELECTRICAL 2013 Additional desc . Permit Fee 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/29/14 Qty Unit Charge Per Extension 1.00 23.8300 EA ELEC TEMP POWER POLES 23.83 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL - TEMPORARY POWER FOR HOUSE THAT CAUGHT FIRE. 2010 CALIFORNIA CODES. ---------------------------------------------------------------------------- Other Fees PLAN CHECK, ELECTRICAL 16.68 Fee summary Charged Paid Credited ----------------- ------ --- ---------- ---------- ---------- Due Permit Fee Total 23.83 .00 .00 23.83 Plan Check Total .00 .00 .00 .00 Other Fee Total 16.68 .00 00 16.68 Grand Total 40.51 .00 .00 40.51 LQPERMIT Bin # City Of L.. Quint Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # /.�, , # �� K `�� Project Address: 2 �(�� / wner's Name: A. P. Number: Address: Legal Description: `v City, ST, Zip: Contractor: F Address: 3 � Telephone Project Description: City, ST, Zip: c� TeleP hone: khm r y • State Lic. # : 7 City Lic. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person:OS C ''s`><�??si>.'>�>>?<sN�?�<'.>.'?�>��ss: ! Gr �� q. Constraction Type: l an cY� F Project tYPa circle one): New Add'n Iter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: k06' • °� 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 C21cs. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees