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09-0454 (ELEC)Applicant:. Architect or Engineer: � Vie -- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Business and Professionals Code,.and my License is in full force and effect. License Class: B icenseNo.: 793303 Dater/7�Contractor. OWN -4,2,E . R DECLARATION I hereby affirmunder penalty of perjury that I am exempt frorti`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 pursuantto,the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7006) of Division 3 of the Business and Professions Codel or that he or she is exempt therefrom and the basis for the alleged.,exertmption.. 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).: (_ 1 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 orofferedfor 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.l. • I . ' � , (_ I 1, 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 vAo builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( I 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: LQPERA11T VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/12/09 Owner: )r n MARSHALL, SALLY �U [rig 78715 SAGEBRUSH AVE LA ( �'� 2009 Contractor:g'.l°: PRECISION BLDG & RESTORTN INC 10722 ARROW ROUTE, #416 RANCHO CUCAMONGA, CA 91730. (909)980-1701 LiC. No.: 793303 - 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 forwhich_this permit is issued. My workers' compensation insurance carrier ana,policy number are: ' Carrier STATE FUND Policy Number 0600433-2008 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 shat forth w,i he ply with those provisions. Date: Applicant: WARNING: FAILURE TO SEC E WORKERS' COMP ON 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, eachpersonat 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 construct'' an rebs uthorize representatives of this county to enter upon the above-mentioned property f t in ec '6 es. Date: �ignature(Applicant or Agent): G LQPEFtA11T Application Number . . . . . 09-00000454 Permit . . . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee 33.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/08/09 Qty Unit Charge Per Extension_ BASE FEE 15:00 1.00 18.5000 EA ELEC SVC <=600V/<=200A. 18.50 ----------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL SERVICE CHANGE 100 AMP TO 100 AMP. ----------------------- .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 Bin # City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # - Project dd : ' 7 aq e h V v S1 rt f _Owner's' -Name: A. P. Number: Address:r V sk 47yU Legal Description: ,City, ST, Zip: ,�� �Contcactor:�1'd �G� $ o ti GI i jZ¢ ,Telephone " 's ?: ' ::< ••• TAddre5 D 7 ZZ ✓o w v /6. -t =P_rojecfMscription: City, ST; Zip: t� L�CJt.G UCGi ivtlj 4_ / 7,30 Telephone: � �<�;:<�:;<.;:#;s•`•'>:<>::>:<::; � :l.:;>.;::: ,: ACity-Licr#;, 0 Arch., Engr., Designer: v Address: City., ST, Zip: Telephone: z <'::i: tr;iiA 4`hy •:::: •: •• Construction Type: Occupancy: State Lic. #:•::.:: . Project type (circle one): New. . Add'n Alter Repair Demo Sq. Ft.: #Stories: #Units: Name of Contact Person:. Telephone # of Contact Person: Estimated -Value oject. @ Z7 D 0 O APPLICANT: DO NOT WRITE. BELOW THIS -LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs.. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person • Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review,,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 r LTota:1P:ermit Fees --.