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12-1084 (ELEC)- -. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,- CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number:. 1200001084 Property Address: 79175 RANCHO LA QUINTA DR APN: 649-370-027- - - Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1000 Applicant[//�//,J Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION 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 Bus and Professionals Code, and my License is in full force and effect. License Class: C10 License No.: 725720 r Date: Z Contractor: OWNER-BUILIER�DE LARATION 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 improvefor 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 Professions Code: The Contractors' State License Law does not apply to an owner of nrone.rty who GvilQs or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 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: 9/21/12 Owner: \ STEVENS RESIDENCE 79175 RANCHO LA QUINTA DRIVE LA QUINTA, CA 92253 Contractor: COCKRELL ELECTRIC INC 590 OLEANDER ROAD C� NpT1G�C PALM SPRINGS, CA 92264 (760)864-6233 Lic: No.: 725720 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 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 REPUBLIC UNDER Policy Number ATW00091100 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 e, Y forthwith comply with those provisions. Date: / Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG '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 ...hnse hanafit wnrk is mrforRled unor or pursuant to any permit issued as a result of this application, . the owner, and -the applicant, each agrees to, and shall defend, indemnify alfa nolo naniaess the CILy 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 f1[1ltahtg•spnstruction, and hereby authorize representatives of this county to enter upon the above-mentioned property fCr=�`nc�eCtionpurposes. Date:. - Signature (Applicant or Agent): Application Number 12-00001084 Permit ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50 Plan_Check Fee .00 Issue Date Valuation . . . 0 Expiration Date 3/20/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA - ELEC SVC <=600V/<=200A 18.50 --------- -------------------------------------------------- Special Notes and Comments CHANGE EXISTING MAIN METER PANEL SAME FOR SAME 200,AMP. 2010 CODES. -----------------_-_------------------------------------------------------- Other Fees : BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 33.50 .00 .00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00. .00 1.00 Grand Total 34.50 .00 .00 34.50 BM f City Of La QUinta Building 8r Safety Division Permit J P.O. Box 1504, 78-495 Calle Tampico 1 La Quints CA 92253 - (760) 777-7012 Building Permit APPlication and Tracking Sheet )C Project Address:7 S %• wner's Name: eN A. P. Number: 1,f _ I Total Permit Fees !I Legal Description: Contractor: C City, Sr, zip: V L' �-' C -� C.� elephone: Address: O Project Description: City. ST, Zip: Telephone: �0 G Z A.)`g e jC State Lic. # : zl 720 City Lic. #Z_..... Arch., Engr., Designer. Address: City, ST, Zip: Telephone: Construction st ruct ' ion Type: Occupancy - State i Lc ------------- Name of Contact Person: Project ' e ct type(circleone): t i New Add'n Alter Repair P Demo `a�Y� Sq. Ft.: # Stories: Telephone # of Contact Person: GD- Z 7C-ZiEj # Units: Estimated Value of Project: oc' t APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING Plan Sets PERMIT FEES Plan Check submitted Structural CaIcS. Reviewed, readv for corrections Item Amount' Truss Calcs. Plan Check Deposit Called Contact Person Title 24 Calcs. Plan Check Balance Plans picked up Flood plain plan Construction Plans resubmitted Grading plan '"' Mechanical Review, ready for corrections issue Electrical Subcontactor List Called Contact Person Grant Deed Plumbing Plans picked up S.M.I. H.O.A. Approval Plans resubmitted IN HOUSE:- ''' Grading Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appy Date of permit issue A.I.P.P. School Fees I Total Permit Fees !I