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09-0611 (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: I ) - 09 0000,061�1'�° 5_2952—AVENIDA OBREGON 773-315-016-10 -000000- ELECTRICAL COVE RESIDENTIAL 600, Td Y .4 ufti. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: 0I -A Owner.: LEO HUBBARD 52952 AVENIDA OBREGON LA QUINTA, CA -92253 Contractor: ELLIOTT CONSTRUCTION 12765.W. ARROYO DESERT HOT SPRINGS, (760)774-3460 LiC. No.: 50.4844 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/10/09. - - 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 D.Msion3 of the Business and Professionals Code, and my'License is in full force and effect. _ _ I have and will maintain a certificate of consent to self -insure for workers' compensation,•tas provided - Licens Class: B -C10:. License N �. - 04844 • ' 'for by Section 3700 of the Labor Code;. for the performance of the work for which this. permit is • at I j' ontractor- _ I have and will maintain. workers' compensation insurance, as required by Section 3700 of the Labor Code; forthe perfo' ance`of the work for -which INi permit is issued. My'vJorkers' compensation . OWNER±BUILDER DECLARATION - .. -I ' • '•- insurance carrier and: policy number are: - I hereby affirm under penalty of --perjury that am exempt from the Contractor's:State.License LaWfor the - .Carrier EXEMPT:. _ Policy Number - EXEMPT . - ;follo'wing.ieason (Sec.3P31 5;?Business a'4Professions Code:-Any'city: or cou_ ntytkat requires a?permit to .f certify that; in the performance of,the work for which this .permit is issued( -I shall not -employ any . construct;-�atter;iimprove, demolish, or repair any structure �pnbi to its issuance ,alsorequires the applicant for the - person inany manner Boas to becomesutiject tothe workers' compensation laws of California, . • permit -,to file a signed statement that he or she is, licensed obr;uant.to.the provisions of the Contraci6r:s.State - - -and agree that, if l-should'become_subject to the.wor rs compe" ion rovisions of section', .License Law (Chapter9lcommencmg'with Section 7000) oPDivision,3.of the,Busmess;and'Professions Codel or 3700of theLab rCode,-I s 1 • o hwith pl" th visa - ' that,he`orshe isexempttherefrom and the basis forthe alleged exemption. Any violation of Section 703.1.5•by - - - any applicant fora permit subjects the applicant.to'a civil penalty of not more than -five hundred dollars IS5001 _: Date�� cant- - ( 1' I, as owner of the property, 6V;ny 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: They - WARNING:= FAILURE TO.SECURE ORKERS'.COMPENSA710N.COV.ERAGE 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,work.liimself or herself.through•his or her:own employees,?provided that the - - D6LLARS.IS100,000).,'IN ADDITION TO THE COST OF COMPENSATION; DAMAGES. AS PROVIDED'FOR IN, improvements are not intended or offered for sale. If, however _the budding -or improvement is sold within - SECTION 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.).- - (_ 1 I, as owner of the property, am exclusively contracting. with licensed contractors.tc construct -the project,(Sec. i •; ••r - 7044 ,Business an`d.Professions Code:. Ttie`Coniractors' 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 1 I am exempt_underSec. ;'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.). Lender's Name: Lender's Address: - LQPERMIT 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 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 isnot 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 constr ion, and hereby authorize representatives of this cV ty to enter upon t e above-mentioned property fore t(on pur Kt S' ature (Applicant or Agent): Application Number . . . . . 09-00000611 Permit . . . ELEC-SERVICE CHANGE Additional desc . ' Permit -Fee . . . . 33.50 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 12/07/09 Qty. Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 7 --------------------------------------------------------------------- Special Notes and Comments UPGRADE PANEL TO 200 AMP SERVICE ---------------------------------------------------------------------=------ 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 N7W R Bin # ty C Of LAI. Qumi-a Bqildlng 8T SJ(gW_Piv41on P.O. Box'.1504, -76-495-- ampico Calle'Tampico La Wqto, Ck9,2253 -,(760)'77-7-70,12 Building erm- lt.-A -P V -and ypl�qq pn:, Track[ng. Sheet Permit # Project Address: Own ..er,,sNam,e A. P. Number: Addres. R Legal Description.* Contractor. Telephoners Address: PrA t Description: L_ -- City, ST, Zip: Telephone: 0 State Lic. # - f1Q ZY q44 �City Lic. #z Arch., Engr., Designer:. Address: City., ST, Zip: Telephone: onstructi n o ype: Occupancy p Project roject -type (circle one):' NeW, Add'n Alter Repair Demo State Lic. Name of ContactPerson: si.6ries: # Unit: Telephone # of Contact Person: - Estimated Value pf-Project: APPLICANT DO: NOT, WRITE. BELOW"THIS # Submittal Plan Sets Reqld Rec!d tR,ACI;WqG 'Plan Checksubmitted PERMIT FEES Item' Amount Structural Cafes. Reviewed, ready for corrections Plklicheck Deposit Truss Cates. - Cont . act Pi I rson 'k , la.fi,,.Check Balance . Tide 24 Cales. ',Plans picked no Flood plain plan Plans resubmitted Grading planReview, ready foriorrections/[SsFe .aMechanical Electrical Subcontactor List Called Contact Person Plumbing V Grant Deed Plans picked up. - 41.6A. Approval Plans resubmitted Grading 31ReYiew,ready for correctidnslissni Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. ApprPate of permit issue School. Fees `Total -Permit Fees