07-2895 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07�0`00028.95'
Property. Address:
52420 AVENIDA RAMIREZ
APN:
773-262-009-• - -
Application description:
ELECTRICAL
Property Zoning:
-COVE RESIDENTIAL
Application valuation:
300
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011,
INSPECTIONS (760) 777-7153
Owner: ! =NOV�,�
11 U
•ED RANDALL �.
X2420 AVENIDA ELA QUINTA, CA 92207 '
U;:i
CITY OF IA'QU114TA E
FINAmrs ncpT: i
Contractor:
D C ELECTRIC SERVICES INC
P.O. BOX 5790
11/05/07
LQPERA11T
LA QUINTA, CA 92248
(76.0)775-30.70
J
'Lic. No..- 800443
.LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION.-
1 hereby, affirm under penalty of,perjury that I am'licens4under provisions of Chapter- :9 (commencing with
'3
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Divisionof theBusiness and -Professionals Code, and.my Cicensq is in full force and effect._�
I have and will maintain a•certificate of consent to self`- insure for workers' compensation,'as provided
License Class: C10 License No.: .800443•:_ .:
dor by Section 3700 of the Labor Code, for the performance of..the work for which this permit;is
`issued. .. .. .. .
Date: Contractor: -
I haveand. will maintain workers' compensation insurance,.asfrequired by Section 3700 of the Labor
_
Code, for the performance of the work for' which thispermit is issued. ,My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier;ind policy number. are: -
I herebyaffirmunder penalty of perjury that,I am. exempt from.the Contractor's State License Law for the
Carrier STATE FUND- Policy Number 238-0003341-07
following reason (Sec. 7031.5, Business and Professions Code: Any' city or'county that requires a permit to.
I certify that, in the performance of the work for. which this,. permit is issued, I shall not employ any,_
construct,. alter, improve, demolish, or.repair any structure, prior to its issuance,,also requires the applicant for the -
person.in any manner so as to become subjet to the workers'.compensation laws of California,
permit to file -a signed statement that he or she is licensed,pursdant to4i�he,provisions of the Contractor's State
and agree that, if I should become"subject to the workers'compensation provisions of Section
License Law (Chapter 9 (commencing with Section -70001 of Division 3 :of the Business and Professions Code) or
3700 of the Labor. Co with those provisions.
that heor sheds exempt therefrom and the basis for the alleged exemption: 'Any violation' of Section 7031.5 by
-penalty
�O
'7
. any applicant for a permit subjects the applicant to acivilof not more.tfian.fi've hundred'dollars 15500L: ,
e: - leant; -
I, as owner. of the property, or my empjoyees with wages.as their sole compensation, will do the work, and
-AND
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLAWFUL, SHALL
Contractors' State License Law doesnotapply, to an owner of,: property.who,builds•or improves thereon,
SUBJECT ANEMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and 'who does the work himself or herself through his or tier own employees,'provided that the
DOLLARS ($160,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the budding or improvement is sold within
:SECTION 3706,OF, THE LABOR.CODE,.INTEREST, AND AT,TORNEY! SoFEES. �+- *-
- one.year•of completion'the,owner builder will hiiWthe'burde"n'Wi roLing that he or she did'not build $r
improve for the purpose of sale.)'
APPLICANT ACKNOWLEDGEMENT
- 1 I, as owner of the-property;am exclusively contracting with licensed contractors to construct the. project (Sec.
IMPORTANT Application is hereby madeto the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply.to an owner of
. conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State Lice
- whose benefit work is performed under. or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C.•for this re
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
r -
I _D
performed under or following issuance of this permit.
_
Date: ner. -
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that thereisa construction lending agency for the performance of the -
1 certify that'( have read this application and state that t e-inE6_ tion is correct. 1 agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).city
and -county ordinances and state laws relating to b "n, nd hereby authorize representatives
of this county to enter upon'the above-mentioned property fo ' spection
Lender's Name:
7
(
Lender's Address:
e: Signatur pplicant or Agent
•' -
^`
LQPERA11T
Application Number . . . . 07-00002895
Permit . . . . . . ELEC-MISCELLANEOUS
Additional desc ..
Permit Fee . . . . 52.50 Plan Check Fee
.00
Issue Date, Valuation
0'
Expiration bate.. 5/03/08
Qty Unit Charge Per.
Extension
"BASE FEE
15.00
1.•00 37:5000 EA ELEC ,SVC <'=60OV/ >2OON/ <=1000A
37:50.
Special Notes and .Comments
ADD: VOLT., 50 AMP GFI CIRCUIT BREAKER
,,-2
FOR -ABOVE GROUND SPA.
Fee summary Charged Paid Credited
--
Due
-- - - - - ----- - - - - -----.-------------------- - - - -,-----------
Permit`..Fee Total 52.50 -.0`0 .00
527.50
Plan., Check Total .,00 00 .00
.00 _.
_ Grand Total. 52.50 .00 .00
52.•.50
LQPERDIIT
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City Qf L.,Quinta
:Building'az SAty,Diy4ion
P.O. Box 1504, 7&495 Caite Tampico
La Quinta, CA 92253 (760)a 777 7012.
Building Permit Applrcationfand Tracking Sheet
Permit
Project Address: 5a:: q 2 D A I/F...11 04 i„•Vi✓n l %l E Z
Owner's Name: ' (-icQ �/�. NG�/� L
A. P. Number:
Address: X g�
Legal Description:
Contractor: t Q / Sr= J /�S Tt/C'
City; ST,�Zip:: �� V r/I/:rr�.. C /� 922 A.17
Telephone: 7, 6 - �
- S” V — 2 �// ME
Address: A 0 .5' % 9t
Project Description;
City, ST, zip: 1AU.A (�A LL2 y%
SuPPe(?A61VT,44. To =s CRM IT
Telephone:
p 77l ` y7 8.
:tit -',.; �; •,.; ,�: .•.�..,�.t,�`F��., �t�y�;
y0.3-3 Needs r ;✓, L Z�s vl
StateLic.#: yy.j City:Lic..k; .3'I6.S.- .
Arch., Engr., Designer:
/3 Ped /-C,17/) 2yo j'b�r 50 AA7P Fs
- E-
Address:
S f}
City, ST, Zip:
Telephone.
•
State Lie.Project
, ��, �,� ,ott � �' K � < .
Construction Type. Occupancy:
type (circle one): New Add'n Alter Repair Demo
Name'of Contact Person:
Sq. FL: v# Stories:
# Units:
Telephone f✓ of Contact Person: 777_920a 6 7- /OA
Estimated Value of Project.
;APPLICANT:: DO NOT'WRITE BELOW `THIS LINE F.
H
Submittal
Req'd.,
'&c' d'
TRACKE-NG
PERMIT FEES
Plan Sets
Plan Check submitted,'.
[tem;
Amount
Strdctural Calcs.
Reviewed; ready,:for corrections
Planr,16eck Deposit
Truss Caica.
Called Contact Person
Plan'.Check. Balance
.Title 24 Caics.'
Plans picked'up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan..
2" Review, ready for: corrections/issue
Electrical
Subcontactor List ..
Called Contact Person .
`P.lunbing
.,Grant Deed
`Plans picked,up
S.M.L
H.O.A. Approval
Plans resubmitted
Croding .
IN HOUSE:-
''d Reyiew, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I:P.P..
Pub. Wks. Appr
Date of Permit issue.
School Fees
Tota Termit Gees
Approved bv: Peso #
❑ Planning Commission
L �( ❑ City Council
ate C�Cornmunity Dev. Dept.
Initials INU4l� �--
CIN OF LA.QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
i l Case No. ,1
Exhibit AQ OVA t-1{t3S�Ac
c�'�L. �I tc.A� ctecst.�T To
_�� .sY -4��-►ate
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or
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