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05-5442 (ELEC)Applicant: Architect or Engineer: aIA ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: T.AVVV RkRAJAS IENI DA .A, CA .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 1 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 heor she�is exempt.therefrom and the basis for the alleged exemption. Any violation ;of Section -70211.5 by any applicant for a permit subjects the applicant to a civil penaltyof not more thanfive'hundreil 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 forsale (Sec. 7044,.Business and' -Professions -Code: The Contractors' State1icense 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`Professionstode: The Contractors"State License Lawdoee not apply fo an owner of property who builds or improves tha id who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' a license Law. 1 ) I am exempt under Sec. , B.&P.C. for this i ate: I `/ — U ner: - 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 RUBIO 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/14/05 WORKER'S COMPENSATIOWDECLARATION _ 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: Sec: i6n 3700 of the Labor Code, 'forthe"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 m 'ne, so,asr s to b o tt subject to the. workers'. compensation laws of California, and agree , if I shouldbeco u je - the workers' compensation provisions of Section �/(�3J700 he Labor Code,1 s tforthwit c mply.with those provisions.- plicant: WARNING: FAIL RE to ORKERS' COMPENSATION COVERAGEISUNLAWFUL, AND SHALL SUBJECT AN EMP 0 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 madeto the Director of Building and Safety for a permit subject to the conditions and restrictions set fohh,.on'this application' 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performedunder 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 relati 81Tgt:e tru ' n, and hereby authorize representatives of this county to enter upon the above -men ' ed property for ins on p poses. Date" ,VB ure (Applican or Agent): ' . P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:A ---00(1-05.44'2 Property Address: 52334 E IDA RUBIO APN: 77.3-253-024-20 -000000- Application description: ELECTRICAL - Property Zoning: COVE RESIDENTIAL Application valuation: 200 Applicant: Architect or Engineer: aIA ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: T.AVVV RkRAJAS IENI DA .A, CA .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 1 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 heor she�is exempt.therefrom and the basis for the alleged exemption. Any violation ;of Section -70211.5 by any applicant for a permit subjects the applicant to a civil penaltyof not more thanfive'hundreil 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 forsale (Sec. 7044,.Business and' -Professions -Code: The Contractors' State1icense 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`Professionstode: The Contractors"State License Lawdoee not apply fo an owner of property who builds or improves tha id who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' a license Law. 1 ) I am exempt under Sec. , B.&P.C. for this i ate: I `/ — U ner: - 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 RUBIO 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/14/05 WORKER'S COMPENSATIOWDECLARATION _ 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: Sec: i6n 3700 of the Labor Code, 'forthe"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 m 'ne, so,asr s to b o tt subject to the. workers'. compensation laws of California, and agree , if I shouldbeco u je - the workers' compensation provisions of Section �/(�3J700 he Labor Code,1 s tforthwit c mply.with those provisions.- plicant: WARNING: FAIL RE to ORKERS' COMPENSATION COVERAGEISUNLAWFUL, AND SHALL SUBJECT AN EMP 0 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 madeto the Director of Building and Safety for a permit subject to the conditions and restrictions set fohh,.on'this application' 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performedunder 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 relati 81Tgt:e tru ' n, and hereby authorize representatives of this county to enter upon the above -men ' ed property for ins on p poses. Date" ,VB ure (Applican or Agent): Application Number . . . . . 05-00005442 Permit ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 52.50 Plan Check Fee .00 Issue Date . . ... Valuation . . . . 0 Expiration Date 6%12/06 Qty. Unit Chargee Per.. Extension BASE FEE 15.00 1..00 37.5000 EA ELEC SVC <=600V/>200A/<=1000A 37.50' " Special Notes.and Comments ------------------------------ 400''AMP METER SERVICE.INSTALLED TO _ ACCOMODATE NEW ADDITION_-.. ,. Fee summary Charged.:..' Paid Credited-. Due - - -- -- -----. -- ---- --------- ----------------- y Ver'mit Fee Total :52. 50 00 00 52 - 50 ' P1 an Check:Tota1 00. 00 -00 00 Grand­,,ToCal 52.50 :.00, .00. 52'.50 LQPERMIT 'Bin # . City of - La Quints Building U Safety- Division P.O..BokA 564; 78=495 Calle Tampico La Quintai .CA 92253. - (760) 777-.701:2 •- Building Permit Application and Tracking;Sheet Permit # Project Address:' 3 3 Owner's Name: A. P. Number: Address: S'a 3 6� Legal Description: City, ST; Zi /J Contractor: 6 Telephon Address: Project Description:' City, ST, Zip: Telephone: Yt State Lie. # : City Lie. #: 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 Contact Person: Sq. Ft.:#Stories: # Units:. i Telephone # of Contact.Person: Estimated Value of Project -0 -APPLICANT: DO NOT:WRITE-BELOW, THIS LINE. # Submittal Req'd Recd` TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed,:ready for corrections Plan Check Deposit Truss Calcs. Called.Contact Person Plan Ctieck Balance Energy Calcs. Plans picked up Construction Floodplain plan Plans resubmitted• Mechanical Grading. plan 2nd 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:- ''" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr bate of permit:issue School Fees Total Permit Fees I