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BELC2015-0045LICENSED CONTRACTOR'SDECLARATION I hereby affirm under penalty of.peri'ury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of. -Division 3 of the Business and Professions Code; and my License is in full force and effect. License Class -CIO - License No.: 903670 C' a to - I O — Z a i S" :ontracto t�iL 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 s -ns of the wo k�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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: a I certifyAhat in the performance of the work for which this permit is issued, I VOICE (760) 777-7125 78-495 CALLE TAMPICO city or county that requires a permit to construct; alter, improve, demolish, or repair . workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licenseo:pursuant to the provisions of thecomply with3hose provisions.01 Contractor's State License Law (Chapter,9 (commencing with Section 7000) oiDivision3 ' of the Business and Professions Code) or that he &Fshe is exempt therefrom and the FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: BUILDING PERMIT (� I, as owner of the property, or my employees with wages as their sole ONE!HUNDRED!THOUSAND: DOLLARS ($100,000). IN ADDITION TO THE COST -OF compensation, will do the work, and the structure is not intended or offered -for sale. - COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors, State.License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for.sale. If, however, the, build Ing orimprovement-is:sold IMRORTANT:Application. is hereby, made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that Date: 6/10/2015 Application Number: BELC2015-0045 request and for wfiose;benefitwork is performed under or pursuant to any permit Owner: . issued as a result of this application , the owner, and the applicant, each agrees to, and 'nd'Wd State License Law does not apply to an owner of property who builds or'improves Property Address: 54305MENIDA RAMIREZ employees for.any actor omission'related to the work being performed under or VENTURES -TRUST following issuance of.this permit. (_) I am exempt under Sec. B.&P.C. for this reason APN: 774243015 7500 OLD GEORGETOWN RD S7 Application Description: VENTRUES TRUST/ MAIN ELECTRICAL PANEL WORK BETHESDA,tMD 20814 Property Zoning: Application Valuation: $350.00 z c') � � Z D Applicant: Contractor: VICTOR VALLEY ELECTRIC VICTOR VALLEY ELECTRIC mp P O BOX 463'P O;BOX 463 0 �p C YUCCA VALLEY, CA 92286 YUCCA VALLEY, CA 92286 D (760)900-0433 LIc. No.: 903670 LICENSED CONTRACTOR'SDECLARATION I hereby affirm under penalty of.peri'ury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of. -Division 3 of the Business and Professions Code; and my License is in full force and effect. License Class -CIO - License No.: 903670 C' a to - I O — Z a i S" :ontracto t�iL 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 s -ns of the wo k�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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certifyAhat in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, .Business and Professions Code: Any shall not employ any person in'any manner so as to become subject to the workers' city or county that requires a permit to construct; alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its.issuance, also requires the, applicant for the permit to'file a workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licenseo:pursuant to the provisions of thecomply with3hose provisions.01 Contractor's State License Law (Chapter,9 (commencing with Section 7000) oiDivision3 t S. of the Business and Professions Code) or that he &Fshe is exempt therefrom and the Dat Applicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER.T.O'CRIMINAL PENALTIES AND CIVIL FINES UP.TO (� I, as owner of the property, or my employees with wages as their sole ONE!HUNDRED!THOUSAND: DOLLARS ($100,000). IN ADDITION TO THE COST -OF compensation, will do the work, and the structure is not intended or offered -for sale. - COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors, State.License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for.sale. If, however, the, build Ing orimprovement-is:sold IMRORTANT:Application. is hereby, made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). ' 1. Each person upon whose behalf this application is made, each person at whose (� I, as owner. of the property, am exclusively 6ritractingwith licensed contractors, request and for wfiose;benefitwork is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Coded The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and 'nd'Wd State License Law does not apply to an owner of property who builds or'improves shall defend, indemnify harmless the City of la Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for.any actor omission'related to the work being performed under or the Contractors' State License Law.). following issuance of.this permit. (_) I am exempt under Sec. B.&P.C. for this reason 2. Anypermit 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 work1or380 days'will subject permit to cancellation. Date: Owner: CONSTRUCTION'LENDING AGENCY I hereby affirm under penaltyof 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: I certify that I haveYead'this application and state that the above information is correct: +agree to comply with all.city and county ordinances and state laws relating to building construction, and heieby.authorize representatives of this city tgenter upon the above mentioned -property forririspection purposes. Date riQ �f5 Signature (Applicant or Agent): f vMq' L3.�.�ee: yc #fir U nv' aa:.s� 2 $e 4 ?/ < J tas + rx »x� x ug ' 1( PAR ? OUNT � _DESCRIPTION, AMOUNT PAID}DATE . ;,, �0� A .. Q BSAS 561473 FEE 101 0000-20306 r 0. $1:00 s $0.00 . " ^ Y yt PAIOfi� E'IiiPi?T+.':#} NOLTUJB{iRY,'aC ka:..<..vYax52 'k "`.Sy�Px� _M.EtT�HOD. _". A sR!s.EC'i"4. •tNWM Total PforBSTA ADMINISTRATI BSA;' °$1 00 i ' $0.00 aidUILDING NDARDS;ri _ ..',a ,... ..... ..[. t...r;.. ., ;. ,:.r , I ., " '+�f7i. -' .. �, :t6N"'h S 25:i9Y.4`tri �k �j P- .,m{+u' � �4 �.��r•. J.4tr9.F4 iae•Yf'3� \:'�� :Y .•` Leif x i .�r+t�;YXafk54�S. ., k, �3f 7� f- -F3L �.^��a,. �_. ,�•ry-$i,-°"Eiyal�� Ri}<j�.. i wC . •o�fi�.3 .X 'aN..�.^_kn.�4+' .-5,� t�. ,..,�-(, xU��'-m�nhl4-Krtb.`+i.{,�.,eiFi�h't.�'f .•Sit"_+. �L.Y•' h>.+; _$r ,vte.(fa933. �.e ,JFR..i fi. CY _+�,�...ai' �.�i�'�.�.�iSn'S..a.".. �^t ..Ee;29 1:tl:L'.�.::1»?2.,-ixa: OTHER ELECTRICAL EQUIPMENT 101 0000, 42403 0 $24 17 $0.00 _. �$•n"t...��7rt3hc � `t�Ya3or �. ��N '�_r� �e'S'�•�^L�ia.Si�4ti;ir:'�""�,�. �s�'��', METHOD,r��i�� ../ a � :ei iY,n.�L3t� 'oaf-. � �� `��s+�'.SiSn.'rXt*!�'xF�y,.<rY..'q �s�CHECKA# :y�.�aZ-h-i`.'r t �FAIU�B�y��"�'�� c sti°fit` �k �a . � RECEI�PFTs�#� ter,{tea: ?irNUT f •'.. fj� 4 ktlhR Ss' ..xyj Kfi •Yldi{ 'z• DECIFTIONa t ` �.�� ACCO,UNTQTI(AMO.UNTxi aS+N' Fl �j,+' H I M ;F:.y..-1119:. J PAID Q PAID DATE xs � w:. y� � ...eK „dsr.+ a,:Laaa.,s:K:..:,..0.d;, c. ,f+.,� .:2 ..'.tx.src..&:s u;:�ra-�' „:x . �d�i� i; �,�,'.'.�>✓i ?3t:�Y.,�;=.a.�..-,�:'ai...„ _', .. ,,._ �r'�-ti, ica�+..-.`'.tN.x..�` '�fi:.:�5.-=:ir>rx OTHER ELECTRICAL'EQUIPMENT PC..: --101-'0000-' 2600 .., k•, 0 $24' 17 = n $0:00' +%1t} y`r t•!','ij`fiC`h':j.:.;d+e3i S . " r,f : �Y i'-" j ;1. 7 abs-:}Vt7`i¢c4L•1:',TFy?=@, r"7Ts'r;h .4';.:. fi' x.Pc x. �r; RECEI CHECK #�x U law :iizp pr ry '.. f "i5 Nm ' ��METHOD # a ACL BY Total;Paid forELECTRICAI $48 34 $0.00 f . �+ ,:s�.;;a�• T, i.v.M.�:.'>'„s/j.:.d'✓:1S' f5 �f.�*�.. •'• if��..... z .� �rxa .#?;�' stcd{ug.+;r�t-1Y,ir. t' - ^fix •y{`{mACCOU.NT+ .� �+, 'fi �n ..h rb b� .G,v r 9'x,-. �� -, AMOUNT I .:t�� .fkA �y?,DESCRIP(TIONR��'„.' �6..51.?fd._..:....._.t....�,x.l,i...]}'aH+..�f ttv� Z�rc','.�..'._•�'.5'7.F•.�i Vhlv..Kif?...t*�Y.....va..i1.AYY.:•.F1.n�.`C. ;::`y'PAID max..=gaPAIDDATE ,...._.a�l3id!?�...F.•.ki.. _.3�1 PERMIT` ISSUANCE A° 1010000'42`404 0 $91T85 $0:00 Y. MAINE ..�.±K 511101RA ddfOfjPERMIT I55UANCE r y�'� 591 85 $Q00• t Description: VENTRUES TRUST / MAIN ELECTRICAL PANEL WORK Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 6/10/2015 SKH Approved: Parcel No: 774243015 Site Address: 54305 AVENIDA RAMIREZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 288 Lot: 4 Issued: UNIT 26 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $350.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: ELECTRICAL -REPAIR EXISTING PANEL AT SHEATH SOCKET. 2013 CALIFORNIA BUILDING CODE. APPLICANT VICTOR VALLEY ELECTRIC P O BOX 463 YUCCA VALLEY CA 92286 .DBJEFFRIES@YAHOO.0 OM CONTRACTOR VICTOR VALLEY ELECTRIC P O BOX 463 YUCCA VALLEY CA 92286 DBJEFFRIES@YAHOO.0 OM OWNER VENTURES TRUST 7500 OLD BETHESDA MD 20814 GEORGETOWN RD STE 135 FINANCIALINFORMATION Printed: Wednesday, June 10, 20159:27:22 AM 1 of 2 . SYSTEMS Printed: Wednesday, June 10, 2015 9:27:22 AM 2 of 2 CIFWSYSTEMS -7 ' N QTY AMOUNT TE1,RECEIT- ,CHECKDESCRIPTIO BSAS SB1473 FEE 101-0000-20306 0 $1.00 '$0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: OTHER ELECTRICAL 101-0000-42403 0 $24.17 $0.00 EQUIPMENT OTHER ELECTRICAL 101-0000-42600 0 $24.17 $0.00 EQUIPMENT PC Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total -Paid.for PERM IT ISSUANCE:. - $91.85. $0.00 TOTALS: $141.19 $0.00 Printed: Wednesday, June 10, 2015 9:27:22 AM 2 of 2 CIFWSYSTEMS Bin # CityOf a,a� Qunta Building & Safety.Division P.O. Box 1504,; 78-495.Calle Tampico La Qbinta, CA192.25-3 (760) 777-7012. Bu1.t. ing,,, er<`m>t Appl cqt n :and` Tracking Sheet Permit 1i 131. Ol S- (� Project Address: S`% - 3 tis mV� f Owner's Nam oo Address: A. P. Number: Legai Description: .City, ST, Zip: Contractor: 1 CIo>< Pt7 (lt Telephone: Address: Project Description: City, ST, Zip: (,(2 c�T- �ZZ-�1� J'l XIr�6- i9iti C-xns77iv(r /t/ Telephone: • :<}ii>iy i'ii:?>::i..... iii%.L:)i:L:S State Lic. # to (0 City Lie. #•: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: P o e. n Co tiu i e:. ccu Y: s ctonTYP Occupancy: P .# State iLc . 'Pro ect type. (circle ne)• New A'dd'n Alter Repair r Dem 0J Name of Contact Person: I�y1r2'_ jj C Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: 7& 0 Estimated Value of Project: ' 'APPLICANT: DO NOT; WRITE�:BELQW THIS ,LINE t/ Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets -Plan Chkk submitted 'Item. Amount Structural Calcs. Reviewed, ready.for corrections tP1an Check Deposit Truss.Calcs. Called Contaet;Person Plan Check Balance. Title 24 Cates. PIans:pi.&ed,up. Construction Flood plain plan Plans resubmitted. Mechanical Grading plan 2nd Review, ready for:corrections/issue Electrical Subcontactor List Called Contaet.Peeson Plumbing Grant Deed Plans. picked up S.M.I. H.O.A. Approval Plans,resub► .itte.d Grading. IN HOUSE:- :z ?"' Reyiew; ieady.for corrections/issue Developer Impact Fee Planning Approval Called•Contact>Person~ A.I:P.P, Pub. Wks..Appr Date of.permit issue . School Fees Total Permit Fees