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ELEC (11-1217)54775 Avenida Madero 11-1217 P.O. BA 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:0000121 Property Address: 5477!9 A IDA MADERO APN:. 774-264-022-11• -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 600 A....r:— , Architect or Engineer. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: CHAD & RAE EMPEY 54775 AVENIDA MADERO LA QUINTA,,CA 92253 v UCENSED 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 theBusiness and Professionals Code and my License is in full force and effect. License Class: B Li ens o.: 431792 ate: !1 ' It ntractor• Cs 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 ($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.). 1 _) 1, 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 toan 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.). ' Lender's Name: ' Lender's Address: LQPERMIT VOICE (760) 777-7012 . FAX (760) 777-7011 INSPECTIONS (760) 777-7.153 Date: 11/08/11 'r Contractor: ` f 09 20 11 U TR.CONSTRUCTION .- 77224 CALLE POTRERO + Ci/aF (d l/}Jyr LA QUINTA, CA 92253 reAt +L' r R (760)831-1863 Lic. No.: 431792 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under: penalty of perjury one of the following declarations: I have and will maintain acertificate 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 EXEMPT Policy Number EXEMPT I c=at, 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 becom subject to the. workers' compensation provisions of Section 3700 of the Labor Code, I s"orlhwilhomy with th seovisions. ate: plicant:W - WARNING: FAIL EURE WORKERS' COMPENSATION COVERAGEISUNLAWFUL, 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. 1 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 co ructi s c mtio y to enter upon the above-mentioned pro art for and rept' authorize representatives of thiy for pecn pure e nature (Applicant or Agent) LQPERMIT Application Number . . . . . 11-00001217 Permit ELEC-MISCELLANEOUS Additional.desc . Permit Fee . . . 24.00 Plan Check Fee 6.00 Issue Date' Valuation . . . 0 Expiration Date 5/06/12 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 .. .7500 PER ELEC DEVICE/FIXTURE 1ST 20 9.00 Special Notes and Comments PATIO REMODEL: ADD LIGHTS, GFI'S. 2010 CODES. - ------------------.---- - - ------------------------- Other Fees . . .. BLDG STDS ADMIN (SB1473) 1.00 Fee summary. Charged Paid Credited Due Permit Fee Total 24.00 .00 .00 24.00 Plan Check Total 6.00 .00 00 6.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 •.00 31:00 LQPERMIT 3 / rghf- lc.(cA Rv aoi04 l P.Sv I -gyp 1W 1 til► Woe.►cowv , _. WOM f -?7 Avom ill- N\AD Bin. # Crty of La Quinta BufJdhy U Safety Division P.O. Box 15O4, 78-495 Calle Tampico LR-Wnta, CA 92253- (760) 777-7012 Building Permit Application'and Tracking Sheet Permit # Project Address: • %7J` !b 117- A*wlle2 Owner's Name:. 1 h/-- 4 'A. P.'Number.n / Address: XY 775. nade 261 . Legal Description: /1, Contractor. s F City, ST, Zip: /4- Telephone: 7loo geid/ c9l' g Address: 7ZJL Al 112Zn0 Project Description: City, ST, Zip: 22La t. w 4- I 2(o &/r of e V ec7ai 9r' Telephone: W - X I 73 I / State Lic.#: ~ 3 City Lic.#: Arch., Engr., Designer. Address: City., ST, Zip: Telephone: Construction Type:. Occupancy: State Lie. #: Project type (circle one): New Add'n' Alter Repair Demo Name of COWAd Person: Sq. Ft.: #Stories: #Univ Telephone # of Contact Person: Estimated Value of Project d• a m APPLICANT: DO NOT WRITE BELOW THIS LINE . N Submittal Req'd Recd .. TRACMG PERXlT FELLS Plan Sets Plan Check submitted Item Amount Sh gctural Cala Reviewed, ready for corrections Plan Check Deposit. . Trust Calci. Called Contact Person Plan Check Balance. Title 24 Calcs. Puna picked up Construction Flood plain plan • Plans resubmitted Mechatilcal Gi acting plea 2" Review, ready for correctionsRssue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plana picked up S M,L H.O.A. Approval Plans resubmitted Grading 61 HOUSE;- Review; ready for torrecdo'nsAssue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees.