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12-0399 (ELEC)t P.O. BOX 1504. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number 12-00000399 Property Address: 78172 SAN TIMOTEO. ST APN: .646 -160 -021 - Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1250 Applicant: Architect or Engineer: i1a ------------------ 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: C10 License No.: 944894 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).: (_ 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 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.). 1 _ I 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.). I—) I am exempt under Sec. , BAP.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 Owner: WESSELS RESIDENT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/12/12 78172 SAN TIMOTEO ST LA QUINTA, CA 92253 A IUIr � � VIII APR 13 2012 Contractor: MOX ELECTRIC 54225 AVENIDA MENDOZAL_�7clFa.z.F LA QUINTA, CA 92253 (760)567-3661 LiC. No.: 944894 WORKER'S COMPENSATION DECLARATION 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 EXEMPT Policy Number EXEMPT 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 subjecYto 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 Cod mall forthwith comply with those provisions. Date:r74, C Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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. 1 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 inspection purposes. � a Date: ' Signature (Applicant or Agent LQPERMIT . Application Number . . . . .. 12-00000399 Permit . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . 33.50 Plan'Check Fee .00 Issue Date Valuation .. 0 Expiration Date 10/09/12" Qty Unit Charge Per Extension ; BASE FEE 15.00 1.00" 18.5000 EA ELEC SVC <=600V/<=2OOA. 18.50 -- - Special Notes and Comments REMOVE OLD 200 AMP MAIN BOTTOM FEE; - UPGRADE .NEW 200'AMP"BOTTOM FEE MAIN PANEL. 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 LQPERMIT . Qty of'. La QuInib . Buikr1ng u. Surety Dw0n . P.O. Box 1504,76-49.5 Calle Tampico, La.Quinta, CA 92253 - (760) 777-7012 Budding PermitA 1kation and Tracking Sheet pp g Permit # ' A Project Address: IrlZ 5 i PD Owner's Name:.'Ja A. P. Number Address: %_217Zft Legal Description:. ,,` 7(q City, ST; Zip: ` U hyfe Contractor: PC O t� Telephone: 3sa Address: Ztg"Ut �i 0 Project Description: / p City, ST, Zip: � V e �0►./ ` / Zzs`3 AO 44 6144 1 3 0& 0.% Telephone. � �� '"a i ��.�"" ..�:. ., 7 o -s6 :Y f ' u PAA.Jle State Lic. #: y City Lie. #; Arch., Engr., Designer- esignerAddress: Address: City, ST, Zip: Telephone: v w ' ' ° Y h ' ✓'d .o State Lic. #: , ¢�y Name of Contact Person: Construction Type: go Occupancy: Project type (circle one): New Add'n AlterRepair o Sq. Ft.: # Stories: I #Units: 1 Telephone # of Contact Person: �(0 5 6-'3 Estimated Value of Project; .ems APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACK NG PERMIT FEES Plan Sete Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact PersonPlan Check Balance, Title 24 Calm Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 2'` Review, ready for correctionsliissue Electrical Subcontactor List Called Contact Person' Plumbing Grant Deed Pians picked up B.O.A. Approval Plans resubmitted Grading - IN HOUSE:- ''" Review; ready for correetionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees