07-2967 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
'LA QUINTA, CALIFORNIA 92253
c&ty/ 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00002967
Property Address: 52960 AVENIDA OBREGON
APN:. 773-315-011-11 -000000-
Application description: ELECTRICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 1000
Applicant: !.� Architect or. Engineer:
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under. provisions of Chapter 9 (commencing with.
Section 700 of Division 3, 6f the Business and Professionals,Code,'and-my 'License is in full force and effect.
License Class: _ 1'0• C20 License.No.:; 393139
Date& — % Contractor: L' -
OWNER -BUILDER DECLARATION
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 io 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 155001.:
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 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 throughhis or her own employees; provided that the
improvements are'not inteinded'or offered for sale.. If, however, the building or improvement is.sold within '
one yearTof completion, the owner -builder will have the burden of proving that he or she did not build or
improve forthe purpose of sale.)
1 _ 1 I, as owner of the property; am exclusively contracting with licensed contractors to construct,the project (Sec.
.7044', Business and.P.rofessions 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 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:
LQPERMIT
Owner:
MOLDENHAUER FRANK MITCHELL
80765 SNOW CREEK WAY
INDIO, CA 92201
(760)347-5949
Contractor: .
OSUNA'AIR COND & ELEC
85495 ARABY.AVENUE
COACHELLA',.CA 92.236
'(760) 398-6355
Lic. No.: 393139
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/16/07
------------------
WORKER'S: COMPENSATION DECLARATION
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
issued.
I have and will maintain workers' compensation insurance, as require&by Seciion.3700 of the Labor,
Code, for the performanceof the work for which this permit.is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the pe?formance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' comperisation laws of California,
and agree that, if l should become subject to the workers' compensation provisionsof Section .
0 of the Labor Code, l shall forthwith ccompl/y.with those provisions.
Date,__ %. Applicant: u�ift�! r/� CJ 4'�'�.. .
WARNING: FAILURE TO SECUREM ORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO -ONE HUNDRED. THOUSAND
DOLLARS ($100;000). 1N ADDITION TO THE 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 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 agreesto, 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 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
�rifor inspection purposes.
e�e;-
-Dat.?''Signature (Applicant or Agent): 1/4 - '-
v
Application Number . . . . . 07-00002967
Permit . . . ELEC-SERVICE CHANGE
Additional desc . .
Permit Fee . . . . 33.50 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 5/14/08
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 EXISTING 100'AMP / VANDALIZED
ELECTRICAL SERVICE PANEL
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 33.50 .00
----------
.00
33.50
Plan Check Total .00 .00
.00
.00
Grand Total 33.50 .00
.00
33.50
LQPERMIT
,p.
Bin #
City of � a Qu;inta:
Building & Safety Division
P.O. Box 1504, 78=495 Calle Tampico
La Quinta,'CA•92253, (760) 777-7012
Building -Permit AppBcition and Tracking Sheet
�. .ry
Permit #
�.
Project Address: b$7c, �CjN�i c�'
Owner's Name:
A. P. Number: Z
Address:
Legal Description:
;City, ST; Zip:'
Contractor: (f,U :� �
Telephone:- ?
Address:
Project Description: ` s T' ,
City, ST, Zip: &e) U -t e -LL,!' e 9z. 2 3 C
GO AN r? . < b Z C—Z;� CZE
Telephone:. S`j
State Lic. # 3 c1 ' ' .
3 3 1 City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
.a
.r
Telephone: p
,.Construction
Type: Occupancy:
State Lic. #:
Project type (circle .one): New Add'n Alter Repair Demo
Name of Contact Person:
;Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact:Person: ,;
Estimated Value of.Projqct:
APPLICANT: DO NOT NTE BELOW `THIS LINE
#
Submittal
Req'd
; ^Reed
TRACKING.
f 'PERMIT FEES
Plan Sets
Plan Check submitted •• .
Item
Amount
Structural Calcs.
•,Reviewed;'ready for corrections
Plan'Check Deposit
Truss Calcs.. •
Called Contact PersonPlan..
Check. Balance
Energy Calcs.
Plans.picked'up. r
• Constrgction
Flood plain plan
Plans resubmitted
'Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactorr-List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval.
Plan's resubmitted -
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developerlm pact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees