ELEC (10-1205)52681 Avenida Martinez
10-1205
P.O. BOX 1504 VOICE (.760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/08/10
Application Number: 10-00001205 Owner:
Property Address: 52681 AVENIDA MARTINEZ WILLIAMS HERMAN
APN: 773-301-020-7 -000000- 52-681 AVENIDA MARTIPRYNA
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL --------------------Application valuation: 700 U 2010Contractor:Applicant: Architect or Engineer: Owner gQU1NTA
6 O61PT
.1 ------------------------------- --
r
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
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 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
n applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
( 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 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 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—) I am exempt under Sec. B.&P.C. for this reason
/Date:
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
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.
mate:plicant:
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 building construction, and hereby authorize representatives
oft 's county to enter upon the above-mentioned proper //for insppyyection pu oosses. _
Date u ' nature (Applicant or Agent)A &&1;&1 f/ _
Win..
Application Number . . . . . 10-00001205
Permit . .
. ELEC-SERVICE CHANGE
Additional desc .
.
Permit Fee . . .
. 33.50 Plan Check
Fee
.00
Issue Date . . .
. Valuation
0
Expiration Date
5/07/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A
18.50.
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Speci'al Notes and
Comments
NEW 200 AMP METER
PANEL TO BE LOCATED AT
SIDE OF RESIDENCE.
2007 CODES. SEE
PERMIT # 10-462 FOR OWNER - BUILDER
INFO.
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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
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Bin #
City of La Qiiinta ,
Req -d
%Kldft 8i Safety llhUmn L
Permit #
P.O. Box 1504, 78-495 Cage Tatnpko 0
La Qu€ ita, CA 92253 - (760) 777-7012
'1
Building Pelt Application and Tracking Sheet
Pro—jam Address: 6o;?aZ
g%
E flssr¢es'sire
A- P. Number.
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Legal Description:,
ST -,Zip
Pdaaa resubmitted Mecbanical
Address:
j Pioject Description-
City, ST, Zip:el a tJ7 t!T
ti
Telephone:76 6— 7 -7
Subcontactor List
State Lic. # :
city Lic #:
Arch-, E►gr-, Designer
Grant Deed
Address.
Plain pkited op S.I%LL
City, ST, Zip:
ii.O.a Approval
Telephone:
C.oushim ien Tylre: Uccapancy:
State Lic #:
Project type (circle one): 'New Add'n Alter Repair Demo
Name of Contac! Petsox:
4 : #Stones Units:
Telephone # of Contact Person:
cd dahat 700
Al?PUCAM,r- rM KMIT VFJVaTF Rpr rte." 7 TMIZ r MM
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Submittal
Plan Sets
Req -d
Ree'd TRACE3WG . PERMIT FEES
Ija Deck sr:bmitted item Amonnt
Structural Cres.
Revier;ed. ready f(w cmvefiow Pian Geek Depot
Truss Catcs.
Called Cemtaet pas= Plan Chmek Balance
Energy Calc►.
Hass girded up Constmetion
Flood plain plan
Pdaaa resubmitted Mecbanical
Grading plan
i'' Recira•, rextty for cerreedeus&-;.,»c Electrical
Subcontactor List
Called Contact Person PlamMag
Grant Deed
Plain pkited op S.I%LL
ii.O.a Approval
Plans resubmitted. Grading
IN ROUSE -
,
' ' l2tHitcr, ready fur r t Devetoper impact Fee
Planning Approval
Called Contact Person A. p_
P. nb. Wks. ilppr
Bate cc ptrmit issce
School Fees
Total Permit Fees