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BELC2016-0067Applicant: BRADLEY ELECTRIC INC 42215 WASHINGTON STREET SUITE A381 PALM DESERT, CA 92211 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License C ss: CSO License No.: 27 L dow Contrac 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 a4 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 4aw 78-495 CALLE TAMPICO . Lim a LL LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT Z f� N BUILDING PERMIT I Application Number: BELC2016-0067 Owner: Property Address: 52155 EISENHOWER DR JED BABBIT APN: 773225018 U r}- 52155 EISENHOWE Application Description: BABBIT / UPGRADE 100 THREE PHASE SYSTEM TO 200 AMP LA QUINTA, CA 922 Property Zoning: Application Valuation: $4,500.00 Applicant: BRADLEY ELECTRIC INC 42215 WASHINGTON STREET SUITE A381 PALM DESERT, CA 92211 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License C ss: CSO License No.: 27 L dow Contrac 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 a4 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: G� o BRADLEY ELECTRIC 1 cD 42215 WASHINGTON STREET SUITE A381 PALM DESERT, CA 92211 (760)360-0944 Llc. No.: 275466 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 othork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by 00 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: STATE COMPENSATION INSURANCE FUND Polic mber: 9084693 I certify that in the performance of the ork for which this ermit is issued, I shall not employ any person in any manner so as t become subject to he workers' compensation laws of California, and agree that, if I ould b su to the workers' compensation provisions of Sectio of abor Code, sha r h complAwithVhose provisions. WARNING: FAILURE TO SECUR ORKERS' COMPE AMON-ECIVERAGE IS UNC L, AND SHALL SUBJECT AN EMP YER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDOLLARS -1-06,000). 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 aboinformation is)correct. I agree to comply with all city and county ordina and state I s relating t Ming construction, and hereby authorize re r taUv upo above lone' pro erty for i pection purposes. Da Signa ure (Applicant or �+ Lim a LL Z f� N I (�o IUB Q � U r}- 1 Contractor: G� o BRADLEY ELECTRIC 1 cD 42215 WASHINGTON STREET SUITE A381 PALM DESERT, CA 92211 (760)360-0944 Llc. No.: 275466 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 othork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by 00 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: STATE COMPENSATION INSURANCE FUND Polic mber: 9084693 I certify that in the performance of the ork for which this ermit is issued, I shall not employ any person in any manner so as t become subject to he workers' compensation laws of California, and agree that, if I ould b su to the workers' compensation provisions of Sectio of abor Code, sha r h complAwithVhose provisions. WARNING: FAILURE TO SECUR ORKERS' COMPE AMON-ECIVERAGE IS UNC L, AND SHALL SUBJECT AN EMP YER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDOLLARS -1-06,000). 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 aboinformation is)correct. I agree to comply with all city and county ordina and state I s relating t Ming construction, and hereby authorize re r taUv upo above lone' pro erty for i pection purposes. Da Signa ure (Applicant or �+ r J Date: 8/3/2016 Application Number: BELC2016-0067 Owner: Property Address: 52155 EISENHOWER DR JED BABBIT APN: 773225018 52155 EISENHOWER Application Description: BABBIT / UPGRADE 100 THREE PHASE SYSTEM TO 200 AMP LA QUINTA, CA 92253 Property Zoning: Application Valuation: $4,500.00 Applicant: Contractor: BRADLEY ELECTRIC INC BRADLEY ELECTRIC INC 42215 WASHINGTON STREET 42215 WASHINGTON STREET SUITE A381 SUITE A381 PALM DESERT, CA 92211 PALM DESERT, CA 92211 (760)360-0944 ---------------- ---------------------------------------- Llc. No.: 275466 ---- --------------------------------- Detail: UPGRADE 100 AMP THREE PHASE SYSTEM TO 200 AMP SYSTEM. 2013 CALIFORNIA BUILDING CODES. r J r l FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC. 101-0000-42600 0 . $12.09 Total Paid for ELECTRICAL: $36.26 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 Total Paid for PERMIT ISSUANCE: $91.85