Loading...
04-4694 (ELEC)C&4f 4 4 a" ."- P.O. BOX 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 cation Number . . . . ._ Appliu 04-00004694 Date 6/01/04 Property Address . . . . . . 46441 ROADRUNNER LN APN: 649-052-018-18 -2667 - Application description . . . ELECTRICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 800 Owner Contractor WILLIAMS JOHN MICHAEL STRZELCZK, EDWARD J. *NOT ON FILE 82231 EAST HELIO COURT UNKNOWN CA 99999 INDIO CA 92201 (760) 578-0201 WCC: STATE FUND WC: 1641435 05/16/05 CSLB: 439904 05/31/05 CCC:. B -C10 -C29 ---------- ----------------------------------------------------------------- Permit . . . . . . ELEC-SERVICE CHANGE Additional desc Permit Fee... 33.50 Plan Check Fee .00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A ,.- 18•.50 -------------------------------------------------------------------------------- Special Notes and Comments METER SERVICE CHANGE OUT FROM 100 AMP.TO 200 AMP Fee summary Charged --------------------------- Paid Credited Due Permit Fee Total 33.50 ------------------------------ .00 .,00,. 33.50 Plan Check Total .00 .00 ..00 .00 Grand Total 33.50 .00 .00 33.50 P.O. BOX 1504. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application .Number: Applicant: m Applicant's Mailing Address: L A VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer: Architect or Engineer's Adcress: Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION i Perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals and my Li s u f e and effect. License Class ­-----�q License No. I hereby affirm under penaltyof . OWNER -BUILDER DECLARATION perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 701.5. Business and city or county that requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicanProfessions Code: Any of statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing witf Section 7000) o Division 3 of the Business t for the permit to file a signed and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation Of Section 70:1.5 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 or 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 orimprove `or the purpose of sale. U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business Fnd 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 projecs with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner I hereby affirm under WORKERS' COMPENSATION DECLARATION . Y 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 ers' compensate n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit.is e My ers' pensati uran rtier ce carrier an •r �LaPolicy Number D � _ I certiry that, III 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 comply with those provisions. WARNING: -FAILURE TO SECURE WORKE$eCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMP -OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (s100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury that there isa construction lending agency LENDING AGENCY Lender's Name for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lenders Address IMPORTANT APPLICANT ACKNOWLEDGEMENT 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 Quints, 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 pemtiL or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this applicatiori and state that the above information is correct I agree to comply wNh all city and county ordlnances and. state laws relating to building construction, and hereby authorize representative of this county to enter u the above-mentioned property for ins P PerfY inspection purposes. /Date �� Signature (Applicant or Agent):