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10-1174 (ELEC)�• , P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 10000=0117 ) Owner: Property Address: 47647 CALEO BAY ACCRETIVE LA QUINTA APN: 643-200-004- - 1 PARK PLAZA #340 Application description: ELECTRICAL IRVINE, -CA 92614 Property Zoning: COMMUNITY COMMERCIAL Application valuation: 15000 Contractor: Applicant: Architect or Engineer: SYSTEM ELECTRIC CO. 1278 MONTALVO WAY PALM SPRINGS, CA 922 v (760)327-7847 Lic. No.: 203019 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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: C10 License No.: 203019 �-Date:- Contractor: 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).: (_) 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.). 1 _ 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: ' 11/04/10 PARTNERS e NOV 04 2010 2 CITY of U1 QUINTA FINANCE DEPT. 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-ihsure'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 LIBERTY INS Policy Number WC2Z91437157690 _ 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith co m ly with those provisions. Date: r 1 Applicant: 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 ($100,000). 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 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 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspe tion puLpoosees. Date: I f 10 Signature (Applicant or Agent) :_ Application Number . . . . 10-00001174 Permit . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 60.00 Plan Check Fee 15.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/03/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 45.0000 EA ELEC PWR APP >100 45.00 ---------------------------------------------------------------------------- Special Notes and Comments ADD 2500AMP [277/480V - 3PH/4W] DISTRIBUTION PANEL TO EXISTING 4000AMP UGPS/2500AMP METER MAIN [277/480V - 3PH/4W] - 2007_CALIFORNIA ELECTRICAL CODE. November 3,.2010 4:08:09 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- .Permit Fee Total 60.00 .00 .00 60.00 Plan Check Total 15.00 .00 .00 15.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 76.00 .00 .00_ 76.00, LQPERMIT — — Cit} Of Ld QC[I11td -- Building 8z Safety MW P.O. Box 1 SO4, 78495 Calle Tampko La Qulnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet apm r[`Aarr. M a.AT vm n_ .... I H . ll Number. Recd p`. P 1. , Structural Caita. Reviewed, ready for corrections Pun Cbeck Deposit MGM Tnrss Cala. FUT WILT, Mw called Contact Person Plan chetk Balance. Titte 24 Caks. l2 I Plea picked cap construction Flood plain plan �� 27 �;f:.,%i`'?��•�:3" �nJ°'.aVn��1Swa c R:r55:�a�•mo�ee�2 . 1 rl 1 1 1 a .ril.•..l (ckde 1 1 ..11 Grading plan ,ei:�:.. ;Qf£'a��.•„2= Name ofConted Pawn: r Ralew, ready for oorrectioasiissue FAeehtcal Subeontactor Ust apm r[`Aarr. M a.AT vm n_ .... I H Submittal Plan Se6 Req'd Recd p`. 'IRACKIIVG Pt3RMIT FEES Pian Cheek submitted .. �r� Item Aaaoant Structural Caita. Reviewed, ready for corrections Pun Cbeck Deposit Tnrss Cala. called Contact Person Plan chetk Balance. Titte 24 Caks. Plea picked cap construction Flood plain plan Plana resubmitted Mechanical r— Grading plan r Ralew, ready for oorrectioasiissue FAeehtcal Subeontactor Ust Called Contact Person Plumbing ^ Grant Deed Plana picked up S.M.L H.O.A. Approval Pians resubmitted Grading ^ Rr HOUSE'- Review, ready for eorrectlonsflssne Developer Impact Fee Planting Approval Called contact Person A.LP.P. Pub. Wks. Appr Date of permk issue u moi' School Fees — _ Total Permit Feu N `3