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BELC2014-103451251 Madison St BELC2014-1034 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application'Number: BELC2014-1034 Property Address: 51251 MADISON ST APN: 777030001 Application Description: TEMP POWER POLE 200 AMP 11 SUB POLES 13 Property Zoning: Application Valuation: $5,000.00 Applicant: DIAMOND POWER SERVICES INC OUTSIDE CITY LIMITS LA QUINTA, CA 92253 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 and Professions Code, and my License is in full force and effect. License Class: License No.: :LIC -010880i Date: Contractor: 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 signedstatement 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 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 ($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, 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.). (_) 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.). 'Lender's Name: Lender's Address OCT 0 7 2014 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/7/2014 Owner: COACHELLA HOLD CO TAHQUITZ CYN WAY A %4"' SPRINGS, CA 0 CITY OF LA QUINTA I POWER SERVICES INC TY DEVELOPMENT DEPARTMP z IDE CITY LIMITS LA QUINTA, CA 92253 (760)290-3330 Llc. No.: :LIC -0108801 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 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: _ Policy Number: _ 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 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I Date: Applicant: 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 Building Official 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 building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Date: Signature (Applicant or Agent): F1 NANCIALIN FORMATION ,DESCRIPT1ON- ACC D `F A66-bmi 1. BSAS SB1473 FEE 101-0000-20306 0, $1.00 $0.00 A I D, i PBY METHOD'>VIRECEIPT #., :CHECK :#,, ,-.`, .t.K5 Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESIERIPT—ION *:, ACCOLIA*Zlllwl :AMOU"NT: :;:,:, DATE Z fry TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 METHCilblk ),? I I RECEIPT RE -K, CHECK,:-,-:-; CLTD BY DESCRIPTIONSACCOUNT.,,",', AMOUNT ' Wlb p AID -DATE iA TEMP POWER SERVICE PC 101-0000-42403 0 $16.92 $0.00 PAID BY.,' METHOD 'CHECK #: CLTD Total Paid for ELECTRICAL: $41.09 $0.00 T,D SC FT - ACCOUNT kits AMOUNT -.pAi 44 PAIDiDATE' z PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID: BY' ETH : RECEIPT Yi :" BY "IV 4,, - X, -il, D Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS: $133.94 $0.00 Description: TEMP POWER POLE 200 AMP 11 SUB POLES 13 BARE POLES Type: ELECTRICAL Subtype: Status: SUBMITTED Applied: 10/7/2014 MFA Approved: Parcel No: 777030001 Site Address: 51251 MADISON ST LA QUINTA,CA 92253 Subdivision: PM 16457 Block: Lot: 1 Issued:. Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: f Valuation: $5,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 .r. : �_ �,. ,3�,..ec..: ,•� 'i ,.za. �', . _ x. a. i.. Details: 1 TEMP POWER POLE 200 AMP, it SUB POLES AND 13 BARE POLES DIAMOND POWER SERVICES INC OUTSIDE CITY LIMITS LA QUINTA CA . . . . . ........ .............. CONDITIONS Printed: Tuesday, October 07, 2014 4:04:38 PM 1 of 2 SYSTEMS Ilk CONTACTS NAME TYPE, ;�� s>.NAME-"�iw �� $�, �ADDRESSl: � x.. �S,T7ATE ZIPz, �� g;,�P,HONE '�� FAX,.`: •EMAIL+ <:}..e .;�:�: € , a ss,�' +tta ., � x ami r��.: a.>«.. , .;-.::-. ' k�.. �- � �,... -.��&.�..C- s _. „CITY �x._- .-a .r ,. =:��. .r. : �_ �,. ,3�,..ec..: ,•� 'i ,.za. �', . _ x. a. i.. APPLICANT DIAMOND POWER SERVICES INC OUTSIDE CITY LIMITS LA QUINTA CA .92253 CONTRACTOR DIAMOND POWER SERVICES INC OUTSIDE CITY LIMITS LA QUINTA CA 92253 OWNER COACHELLA HOLD CO 700 E TAHQUITZ CYN PALM SPRINGS CA. 0 WAY A Printed: Tuesday, October 07, 2014 4:04:38 PM 1 of 2 SYSTEMS Ilk Printed: Tuesday, Odober 07, 2014 4:04:38 PM 2 of 2 CBFWIYSTEMS 77777' "....METHOD DESCRIPTION.: ACCOUNT QTY AMOUNTS PAID; PAID DATE RECEIPT #CHECK PAID BY_ -- BY, TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $16.92 $0.00. PC - I I I I Total Paid for ELECTRICAL: $41.09 $0.00 PERMIT ISSUANCE 101-0000-42404 0—T—$91.85 $0.00 Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS: $133.94 $0.00 .. . ................. INSPECTIONS E 'I ANSP NTY, Ex-: INSPECTOR CHEDU DATE" ELECTRICAL FINAL" Printed: Tuesday, Odober 07, 2014 4:04:38 PM 2 of 2 CBFWIYSTEMS