12-0910 (ELEC)<- RI
P.b. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant:
CSN.w5dc
Tiht 4 4 a"
Architect r En in r:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Business and Professionals Code, and my License is in full force and effect.
LicenseClas/s: C10 D31 LicenseNo.: 937330
Da� te:"� `3 �Z Contractor: G?�
RUDDECLARAWN RTION
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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044,ausiness 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 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
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111, SUITE G
LA•QUINTA, CA 92253
(760)777-9920
Contractor: .
POWER PLUS SOLUTIONS CORP
1210 REDGUM
ANAHEIM, CA 92806
(714)764-0020
Lic. No.: 937330
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/13/12
20'2 e
QdANiA
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 OLD REPUBLIC Policy Number A-ICW37451205
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 comply with those provisions.
I? --
WARNING:
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 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. 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 inspection
nppurrppoo�ses..7
Date:Signat�licant o Agent):
Application Number:12-0
000091_0
Property Address:
8183-0:SEABISCUIT WY
APN:
767-200-999-29 -312023-
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3700
Applicant:
CSN.w5dc
Tiht 4 4 a"
Architect r En in r:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Business and Professionals Code, and my License is in full force and effect.
LicenseClas/s: C10 D31 LicenseNo.: 937330
Da� te:"� `3 �Z Contractor: G?�
RUDDECLARAWN RTION
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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044,ausiness 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 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
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111, SUITE G
LA•QUINTA, CA 92253
(760)777-9920
Contractor: .
POWER PLUS SOLUTIONS CORP
1210 REDGUM
ANAHEIM, CA 92806
(714)764-0020
Lic. No.: 937330
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/13/12
20'2 e
QdANiA
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 OLD REPUBLIC Policy Number A-ICW37451205
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 comply with those provisions.
I? --
WARNING:
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 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. 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 inspection
nppurrppoo�ses..7
Date:Signat�licant o Agent):
Application Number . . . . . 12-00000910
Permit . . . ELEC-TEMPORARY POWER
Additional desc .
Permit Fee . . . 67.50 Plan Check Fee
.00
Issue Date Valuation . .
. 0
Expiration Date .. 2/09/13
Qty Unit Charge Per
Extension
BASE FEE
15:00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE
15.00
5.00 7.5000 EA ELEC TEMP SUB POLE
37.50
Special Notes and Comments
TEMPORY POWER POLE TO PRODUCTION. 1 MAIN
POLE AND 5 SUB POLES AND 3 SPAN POLES
PER APPROVED PLANS.
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 67.50 .00 .00
67.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 68.50 .00 .00
68.50
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City of La Quinta
Building 8i'. Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
/ La Quinta, CA 92253 - (760) 777-7012
�j Building Permit APPlication and Tracking Sheet
JC Project Address: �� 83d
G eSCul ¢ W trl wner's Name: �� ZY� //
A. P. Number: �"'� Q t ��' ��• • P
Address: ,Yyf5/
Legal Description:
� City, ST, Zip: 1VL
Contractor:'
�vwfy w:s elephone: ' ��
Address: ZLt7 Nr I
cr U IM 44,1 Project Des— t'
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4 Telephone:
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Occupancy:
P
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State
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Project e
ct
type
(circle cl
e one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: "
Submittal Req'd
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS
LINE
Recd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2"' Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
"d Review, ready for correctionslssue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees