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06-3690 (ELEC)CV (i P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, .CALIFORNIA 92253 4 4a" BUILDING, & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 LICENSED CONTRACTOR'SDECLARATION 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 Busi�esncl Professionals Code, and my License is in full force and effect. License Cl a B License 807450 ,7Date:^ontractoc' OWNER -BUILDER 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 1$500).: (_ 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 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 I, as owner ofthe 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 whobuilds 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. , BAP.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 10/17/06 WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury one of the following declarations: have and wilbmaintain 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 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 STATE FUND Policy Number 002328472006 _ I 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 become subject to the workers'. compensation laws of California, and agree that, if I shout become subject to the workers' compensation provisions of Section 377�0//0. of the Lab o shall forthwith comp with [ o rowsions. Date: uI �7' lJX7Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN 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 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 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 construction, and hereby authorize representatives of this11cou ty to e((ntter upon the above-mentioned or inspection'Purpo rDateAl` i 1 b nature (Applicant or -Agent).. Date: Application Number: t06y000036-90 Owner: Property Address: 52110 AVENIDA MONTEZUMA MEEKS DAVID APN: 773-201-024-20 -000000- 52110 AVENIDA MONTEZUMA Application description: ELECTRICAL LA QUINTA; CA 92253 Property Zoning: Application COVE RESIDENTIAL 1800 - valuation: ' Contractor: 07CT Applicant: Architect or Engineer: SA WILKERSON INC . 2 71U06 _ 1717 VISTA CHINO STE 7103 PALM SPRINGS, CA 92262 CITY OF LA QUINTA (760)323-.5155 ! FINANCE DEPT. Lic. No.: 807450 LICENSED CONTRACTOR'SDECLARATION 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 Busi�esncl Professionals Code, and my License is in full force and effect. License Cl a B License 807450 ,7Date:^ontractoc' OWNER -BUILDER 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 1$500).: (_ 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 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 I, as owner ofthe 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 whobuilds 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. , BAP.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 10/17/06 WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury one of the following declarations: have and wilbmaintain 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 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 STATE FUND Policy Number 002328472006 _ I 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 become subject to the workers'. compensation laws of California, and agree that, if I shout become subject to the workers' compensation provisions of Section 377�0//0. of the Lab o shall forthwith comp with [ o rowsions. Date: uI �7' lJX7Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN 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 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 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 construction, and hereby authorize representatives of this11cou ty to e((ntter upon the above-mentioned or inspection'Purpo rDateAl` i 1 b nature (Applicant or -Agent).. Application Number 06-00003690 Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee..•: 52.50 -_ Plan Check•Fee .00 Issue Date Valuation 0 • Expiration Date 4/15/07 Qty Unit Charge Per Extension BASE FEE ". 15.00 1.0037.5000 EA ELEC SVC <=60OV/>20OA/<"=1000A .. 37.50 ----------------------------------------------------------------- Special Notes and Comments - '400 AMP ELECTRICAL SERVICE UPGRADE IN PREPERATION FOR ADDITION IN PLAN CHECK. r Fee "summary, Charged Paid Credited --------------------------- Due -.----.----- ---------- " Permit`Fee Total 52.50 .00 0'0 52.50 - "} Plan Check "Total .00 .00 .00• .00 Grand Total 52.50 .00 .00 52.50 LQPERMIT Bin !f City of La Quinta . Building u Safety Division Permit f � P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760)'.777-7012 Building Permit Application and Tracking Sheet Project Address: Sa �� b . B�cJCr �sO q r111CVC ZwlrC� Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip:�� Vd-s Contractor: A c� Telephone: -,206(4 7 Address:. i` -71-7 Lr -/Vt � �'�r Project Description: /";oGG�/C.cc / City, ST, Zip Eck 4-C Telephone: lied y0y. State Lie. # : City Lie. #: Arch., Engr., Designer Address: City,. -ST, Zip: Telephone: Construction Type: Occupancy: P cy: State Lie. #: Project type (circle one):. New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units:" Estimated Value of Project: Telephone # of Contact Person: ` APPLICANT: DO NOT WRITE BELOW THIS LINE ' tt Submittal Req'd.: Recd TRACKING.. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed., ready for. corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Energy Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical'.' Grading.plan .. 2' Review, ready for correctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed . Plans picked up . S.M.I. .. 110A. Approval ... Plans resubmitted. Grading IN ROUSE: Review, ready for correctionstissue Developer Impact Fee: ; Planning Approval Called Contact Person A•I.P.P. Pub. Wks. Appr Date ofpermit issue: School Fees .. ..... ,.. Total Permit Fees ._.:..: :. . License Detail 14 Page 1 of 2 License Detail 'Contractor. License #.807450 CALIFORNIA CONTRACTORS STATELICEN DISCLAIMER A license status check provides information taken from the CSLB license data base. BeforE on this, information, you should be aware of the following limitations: ' . CSLB complaint disclosure is restricted bylaw (B&P 7124.6):. If this entity is subject -tc ` complaint disclosure,'a link for complaint disclosure will appear below. Click on.the lin button to obtain complaint and/or legal.action information. Per B&P 7071.17, only construction related civil judgments reported to the CSLB are disclosed. . Arbitrations are not listed'unless the contractor fails to comply with the terms of•the _ arbitration: .+ Due•to workload, there may be relevant information that has not yet been entered ont +boar d's license data base. L' �''"� '-' ' •' Extract Date: 10/17/2006 5' , *Business Information SA WILKERSON'INC .` 1717 VISTA CHINO S.TE 7-103 1 PALM'SPRINGS CA 92262 4 ' Business Phone Number: (760) 902-4707 Entity. Corporation • , . ,.:Issue Date: 05/01/2002 Reissue Date: 03/01/2004 Expire Date: 10/31/2007, p * * * ;License Status.* r,This license is current'and active. All information below should bel.reviewed.- i r r • * * * Classifications Class Description 0 GENERAL BUILDING CONTRACTOR { * * * Bonding Information CONTRACTOR'S BOND: This license filed Contractor"§'Bond number 10121838 in the an $1.0,000 with the bonding company http://www2.csib.ca.gov/CSLB LIBRARY/License_+'Detail.asp?LlcNLIM-807450 10/17/2006 License Detail j Page 2 of 2 AMERICAN CONTRACTORS INDEMNITY COMPANY. Effective Date: 03/01/2004 Contractor's Bonding History_ BOND OF QUALIFYING INDIVIDUAL(1): The Responsible Managing Officer (RMO) ST ALEXANDER WILKERSON certified that he/she owns 10 percent or more'of the voting stol of the corporation. A bond of qualifying individual is not required. Effective Date: 0/01/2004 * * * Workers Compensation -Information This license. is exempt from having workers compensation insurance; they certified that they employees at this time. ' Effective Date: 09/30/2005 Expire Date: None Workers Compensation History_ * * * Miscellaneous Information Personnel List License Number Request Contractor Name Request ; Personnel Name Request Salesperson Request Salesperson Name Request © 2006 State of California..Conditions of Use Privacy Policy http://w Aiw2.cslb.ca.gov/CSLB_LI B RARY/License+Detai l;asp?LicN tmI=807450 10/17/2006 .