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11-1307 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:— "11-00001307._ 1 Property Address: 78825 HIGHWAY 111 APN: 643-020-999-4 -30903 Application description: ELECTRICAL Property Zoning: REGIONAL COMMERCIAL Application valuation: 300 T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: WASHINGTON 111 LTD 80618 DECLARATION INDIO, CA 92201 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/07/11 AVENUE Contractor: w Applicant: Architect or Engineer: KRIBBS CONSTRUCTION, B UC,0 ;q 78677 SAGUARO DR ! LA QUINTA, CA 92253 140. 1,I Lic. No.: 556693 I`rRa! ��rFnq Npq 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: B C10 License No.: 556693 te� Z -7 I f on tractor:`.� 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 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 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 EX MPT Policy Number EXEMPT *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 1 should become subject to the workers' compensation provisions of Section his 3700 of the Labor Code, I shall forthwith comply with those provisions.. pplicant: �1✓� 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 ($100,0001• 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 1 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 unty to enter upon the above-mentioned property for inspection purposes. ate: !�ture (Applicant or Agent): Application mondbez ' . ' ' ' li-00001307 . Permit ' ' ' ' ' ' oLmo-oonVzco CHANGE Additional deao Permit Fee ' ' ' ' 15'00 Plan Check Fee ' ' 'Vo zoaoe Date ' ' ' ' valuation ' ' ' ' o Expiration Date ' - 6/04/12 ` Qty Unit Charge Per Extension . BASE FEE 15'00 ---------------- -_-----__----_--_---_----_------__-_-_---_----- ial Notes and Comments INSTALL NEW Mezm CIRCUIT BREAKER(8OO xume8) To REPLACE oT0Lom o0JzPxmamT' oOzO CUooG' ---------------------�------------------------------------------------------- Other �Fees ' ' ' ' ' ' ' ' ' BLDG Gro8 xuDMzm (Go1473) 1'00 ' Fee summary Charged Paid Credited -------- ------- ------- Due ------------- ' rezznit Fee Total ------ zs'OO 'oO 'Vo 15'00 Plan Check Total'00 .'oO 'oo 'oo Other Fee Total ' 1'00 '00 'no z'nu Grand Total 16'00 '00 'uo ` ` ' . 16'00 ` ` ' ` Bin # City of La Quints Building 8t Safety DPvisPon . P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 0 t �J << r Project Address: 7. fj R,Z `-/wr Owner's Name: Stfi.� y-��! �� /< A. P. Number: Address: /✓74w Legal Description: City, ST, Zip: � N 3 Contractor: .Goti SrQ .l7 o n� Telephone: . �rA.: >.:�: -..,,.�..,•>,::�:! . ' Address: `JAG 7 S G ki A_ Project Description: City, ST, Zip: 4;4 'Qv/V7',W- U►'' �^ 1 Telephone: 6 0 _ G 9 S / k. ..;>;.;i ;.fig ::.< :. .x >. :.;.c;:;:i ,•,; :� �: • H �.;z.:+..ii:.•yriyf :�l�,Ro.�.c:+< pyww,;»�r:7%f;j;.>..-� :: Y� %3'•£+ 7L �/� Y ` 1 `r u / • V �i{i State Lic. # : S s b 93 City Lic. Arch., Engr., Designer: Address: City., ST, Zip: Telephone: >•+':'•si^° ;.;, ti�,a� ` ::x� ;; y:.. ;+ State Lic. #: ,wµm K :,_.^yy Name of Contact Person: 9R. v c a�, Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repai Demo Sq. Ft,: #Stories: #Units: Telephone # of Contact Person: '7 6,V A.8' S 411-1 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACENG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person Pian Check Balance Tide 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°. Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 1rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr. Date or permit issue School Fees Total Permit Fees