14-0179 (ELEC)P.O. BOX 1504
78-495 CALLE .TAMPICO.
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
_-_1-1T1_--0_0. 0 0 017-9'
57,05AVENIDA OBREGON
773-284-023-10 -000000-
4
BUILDING &'SAFETY DEPARTMENT
BUILDING PERMIT
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- - WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that am licensed urider provisionsof-Chapter 9 (commencing with
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Architect or -Engineer:
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_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
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for. by Section 3700 of the Labor Code; for the performance of the work for which this permit is .
Dater .Z
issued.
_ 1 have and will maintain workers` compensation insurance, as required by Section 3700 of the Labor
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Code, for the performance of the work for which this permit is issued. My workers' compensation
Owner:
BERGER CHERYL
5193,0 AVENIDA
LA QUINTA, CA
(760)771-9035
RAMIREZ
922
r
Contractor:
HOMECO HBC INC. J
560 WILLIAMS RO:�`
PALM-SPRINGSCA
(760)322-0166 �•��Y
Lic. 'No.: 354,141
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
..a a
FEB 2 01014
Date: 2/21/14
- - - - - - - - - - -
- - - - - - - - - - --- - - - - - - - - - - - - - - -7 - -7 - - - - - - - - - - - - - - - —
- - - - - - --- - - - -
' c.. LICENSED CONTRACTOR'S DECLARATION
- - WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that am licensed urider provisionsof-Chapter 9 (commencing with
I hereby affirm untler penalty of.perjury one of the following. declarations-. '
Section 7000) of Division.3 of the:Business and Professionals:Code, ,rid my.License is in'full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: - B : License No.: 354141
'
for. by Section 3700 of the Labor Code; for the performance of the work for which this permit is .
Dater .Z
issued.
_ 1 have and will maintain workers` compensation insurance, as required by Section 3700 of the Labor
1,8Contraaor.-
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 STATE FUND Policy Number 9079104-2013
following reason (Sec. 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, also requires 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 statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that; it I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forth amply with those 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 apermit subjects the applicant to a civil p6nalty.of not more than five hundred dollars ($500).:
ant - 11
(_ 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 offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO'SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND*SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES -AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the workhimself or herself through his or her own employees, provided that the
DOLLARS ($100,000). 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
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
1 _ 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 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
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. CJ.
Lender's Name:
Lender's Address:
LQPERMIT
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 county to enter upon the above-mentioned property for inspectionpurposes.
Application Number . . . . . 14-00000179
Permit . . . ELECTRICAL
2013
Additional desc .
Permit Fee . . . . 23.83
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 8/20/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC
APPLIANCES, NON -RES
23.83
----------------------------------------------------------------------------
Special Notes and Comments
FIRE DAMAGE ELECTRICAL PANEL CHANGE OUT
200 AMP SAME FOR SAME 2013 CBC.
----------------------------------------------------------------------------
Other Fees . . . . . . . . .
BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, ELECTRICAL
11.92
PERMIT ISSUANCE M/P/E
90.57
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 103.49
.00 .00
103.49
Grand Total 127.32
.00 .00
127.32
LQPERMIT
Bin #City
Of Quinta
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -(760) 777-7012
Building Permit Application and Tracking Sheet
Per't #
_l
'tProjectAddress:
e.,O%Vner's Name: NGi Bvo
+A. P. Number. "7.�� -,q 84 _,q3 ,, b r.
Address: 6 &W 164
Legal Description:City,
ST, Zip:
eContractor. " MO LL ' Q� 6A)(1—
:Telephone:
.:::.:......:
Address: � r c_14 J
E jest Description: —,41 1
i. /j
'City, ST, Zip. 5 �o�
e ) 3
Tele hone:
...City -Lic. :-ff. �:�
State Lic. #
Arch., Bngr., Designer.syc�
6) J
Address:
-0
City., ST, Zip:
Telephone:
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Construction Type: Occupancy
'
State Lic. it:
Project type (circle one): New Add'n Alter Re air Demo
;Name of Contact Person:�o ^1
q. Ft.: /%z>�
# Stories: /
# Units: %
J,Telephone #,of Contact Person:. -7(p ` U �D JZ
lE timated Value of Proj /0 6 C�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural C31eS.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2ad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Reyiew, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Scho61 Fees
Total Permit Fees