ELEC (13-1094)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00001094
81506 MERV GRIFFIN WY
767-320-999-30 -32879 -
ELECTRICAL
LOW DENSITY RESIDENTIAL
2700
Architect or Engineer:
4 kgRED
BUILDING &. SAFETY DEPARTMENT
BUILDING PERMIT
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: C10 D31 ^ License No.: 980589
TDate: j 1/J_ Contractor: �au y i•�/�J
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 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 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.).
(_ 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) 777-7153
Date: -''8/30/13
Owner:
IOTA GRIFFIN LLC
81506 MERV GRIFFIN WY
LA QUINTA, CA 92253
D Q
D
Contractor:
A �� 3
POWER PLUS
o
2013
1210 REDGUM
ANAHEIM, CA 92806.
CITY OF(,AQUINTA
(714) 764-0020 FINANCE DEPT.
LiC. No.: 980589
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.
.,x 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 OLD REPUBLIC Policy Number AICW37451306 ]
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 Co e, I shall forthwith comply with those provisions. _
Date: �,+��/'_J�[/ SApplicant: � fra,w 1Y 0_ ..
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 buildin construction, and hereby authorize representatives
//oo�f this county to enter upon the above-mentioned propert r inspection purposes..
Ryate:I Signature (Applicant or Agent):y/
:c . rd�
Application Number . . 13=00001094
Permit ELECTRICAL 2013
+ Additional desc .
Permit Fee . . . 47.66 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date .-'. 2/26/14
�.
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC SERVICES
23.83
1.00 23.8300 EA ELEC TEMP POWER POLES
23.83
Special Notes and Comments,
.200A TEMPORARY POWER SERVICE W/(1)
SUBPOLE - THIS PERMIT DOES NOT INCLUDE
TEMPORARY CONSTRUCTION TRAILER, SEPARATE
PERMIT REQUIRED. 2010 CALIFORNIA
,
ELECTRICAL CODE.
_
August 30, 2013 1:15:16 PM AORTEGA
•----------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
------
1..00 '
PLAN CHECK, ELECTRICAL
28.60 '
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid, Credited
Due
- ---------- ---------- ---------- ----------
Permit Fee Total 47.66 .00 .00
47.66 `
Plan Check Total .00' .00 .00
.00
Other Fee Total 120.17 .00 .00
120.17
Grand Total 167.83 .00 .00
167.83
LQPERMIT
Bin.#
Permit #
Project Address:—�Q
City .�f QU111ta
Budding a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit-Applicadon and Tracking Sheet
.. Owner's Name:.
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
.y .
Telephone:
Contractor. Awas
Address: `N to .
f
Project Description: GI�4 Ora I' DASy,.V O
City, ST, Zip: D .3
D tq C..oKt
Telephone: zov-2Z7
"'Cityu,
State Lic. # : 8o
Arch, Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:Sq.
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft : #Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Strpctural Calcs
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
Called Contact Person
Plan Check Balance
Mile 24 Calci.
Plans picked up
Construction
Flood plain plan
Pians resubmitted..
Mecharileal
Giading plan
2" Rtview, ready for correctiomMiissue
Electrical
SubeoatactorList
Called.ContactPerson
Plumbing
Grant Deed
Plans picked up
ML
H.O.A. Approval
Plans resubmitted
Grading'
IN ROUSE*'-
7j° Review; ready for correetionsftae
Developer Impact Fee
Planning Approval
Called Contact Person
AJ.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees