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BELC2015-0002787495 CALLE TAMPICO LA`QUINTA;-CAL'IFORNIA 92253 Application Number: , . BELC2015-0002 QUM' r COMMUNITY'DEVELOPMENT DEPARTMENT BUILDING PERMIT Property Address: 51140 CALLE PALOMA APN: 7,70143001 Application Description: SERVICE PANEL CHANGE 200 TO 175 Property Zoning: compensation,.as provided for by Section 310O.of the Labor Code, for the performance Application Valuation: $2,000.00 Applicant: 08 DEAN'S ELECTRIC INC d 3283 IRVINGTON AVENUE is issued. My workers' compensation insurance carrier and policy number are: SAN BERNARDINO, CA 92407 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/12/2015 Owner: WILLIAM COVER P O BOX.1160 LA QUINTA, CA 92253 LICENSED CONTRACTOR'S DECLARATION.. © C C Contractor: N _ h r DEAN'S ELECTRIC INC compensation,.as provided for by Section 310O.of the Labor Code, for the performance License Class: C30 License.No.: 497132 3283 IRVINGTON,AVENUE d Z 08 SAN BERNARDINO, CA 92407 d U is issued. My workers' compensation insurance carrier and policy number are: OWNER -BUILDER DECLARATION 2 (909)880-3325 I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Seca 7031.5, Business and Professions Code:,Any LIc. No.: 497132 city or, county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that; if l should become subject to the LICENSED CONTRACTOR'S DECLARATION.. WORKER'S,COMPENSATION DECLARATION I hereby affirm under penalty of perjury that am licensed under provisions of Chapter. I hereby affirm under penalty, of perjury one: of the following declarations: 9 (com(nencing with Section 7000) of Division 3 of the Business and Professions Code,` I.hive -and will maintain.a certificate of consent to self -insure for workers' and my License is in full force and effect" compensation,.as provided for by Section 310O.of the Labor Code, for the performance License Class: C30 License.No.: 497132 of the work for Which this permit is issued. /J _­—Phave and will maintain workers',,compensation insurance, as required by Date:�J��/ Contractor, �✓ Section 3700 of theLaborCode for the -performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: OWNER -BUILDER DECLARATION Carrier:_ Policy Number:_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's'5tate I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Seca 7031.5, Business and Professions Code:,Any shall not employ any. person in any manner. so as to become subject to the workers' city or, county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that; if l should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation, provisions of Section 3700'of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those.provisions. Contractor's State License Lawi(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. �c f / f --12 –I :Applica basis for the alleged exemption. Any violation of Section'7031.5.by any applicant for a atte permit subjects the applicant to a civil penalty of notmore than five hundred dollars . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS.UNLAWFUL, ($500).: AND SHALL SUBkCTAN'EMPLOYER TO CRIMINAL PENALTIES AND,CIVIL FINES UP TO (_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED'THOU5AND DOLLARS ($100;000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure isnot inteinded or offered for sale..:' COMPENSATION; DAMAGES AS PROVIDED FOR 'IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code:.7he Contractors' State License Law does not INTEREST; AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMP,ORTANT:Application ishereby. made tolhe Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that 'r the'conditions and restrictions set forth on this application. he or she did not build improve for the purpose of sale.). 1. Each person uponwhose,behalf this application is.made, each person at whose (_) I, as owner of the property, am exclusively contracting with licensed contractors request and for.whose benefit'work is.performed under or pursuant.to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued asa result.of this application , the owner, and the applicants each agrees to, and State License Law does not apply to an owner of. property who builds.or improves shall defend, indemnify and holftarmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance`of.this.permit. (_) I am exempt under Sec. ..B.&P.C: for this reason 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. 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 Na Lender's 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 consteuction, and•hereby authorize representatives of this city to enter upon the above- mention ed property for inspection purposes: D"at%e/�[! �!� Signature (ApplicaAg' -ent): I' V 'xi'4,'�'.'".',w'?,x-�ti"rC?S�es^.,-�; "�•., "w-T.�:.':,' yae .,r. .;f.1zr':.'::=`:."a' �.,Y;*zs"`iiYhetx.'Si �.: :: ;,,mi'.i`' «DESCRIPTION a''c ' ;:QTY ' "AMOUNT s£PAID = PAID+DATE ,SACCOUNT' BSAS SB1473 FEE ..101 0000=20306. ` 0 $1 00 $0:00 - `1 � " � PAID BY ': ta4 ' . .. MY'E `�� �'. '. �v,.. • �Ci'�?�°$ P�.Aii � ::; S �v. 4Xai°fifri� RECEIPT i1 NN f- x 9 CHECK # CLTD BY 4ke�ST. �....x:A.�'..s:$?3}mi$€:..»x;'".dvLE:.v -'- �+�if „^:'S:'?:`F v ;€ ':S.i"ffi`t�'w�E; A.:3''<:as'Jw`d�$.^� 4ri:'Aa"ixu.+�Y.:k'K rc%'a :u�+s.,�.. <,.:57'K:'"'.dSa«ai ruae:ta' aui..T,!A.3x TotaFPaid focBUILDINGSTANDARDS ADMINISTRATIONABSAc :a $1 00 $0.00 ... 'fw' �DESCRIPTION5; R''i:k',e �.....px.,MOUNT,,.,., 000UNT kQTY a �}" PSAIDi �:.... ."{ 3 g �R`Ei+:'.?k 7sx.ir.. �RCY.k�.'6r:Y.'3(.e'awK`":7-�Ywb'sF,3� !Y -.m i.,i._.J�:'�h.'P�ii::.7:i%'_'f'N,Y�� :AMOUNT= Y. QSdSM.,.R.'4L�M' NIA ix:li�. E1:fw_..:X,e�li�ii�.i'i$• `✓,' OTHER ELECTRICAL EQUIPMENT' .:;' �.. 10 -00Q0-42403, 0 s $241 $0.00 PAIDBnea r- h , aa�. METHOD �Sa�,-,Tu`iMi.: & } 'ill, a :'tCFHs aE. CK. #JA -5:�# ' CXnL�T.- D+ �BY'rv*a c r r: q Y-a':+.:YQ(,ef'S�.�y y ag 4��$RDESCRIPTION£<-.'ter �iw. - ,.s:Gta-.�4 3 .✓ r'e`s ,,.. 'YY;: .3' k , .a Me a±� . > . 4T1(�AMOUNTPAIp110 `..g. -4 a� W t%_' f - a<C..'.a kl. rxm 'yx g`. '4 x ST4 'g, g4,1. PAIUDAT,E Y �A000U���i.� OTHER ELECTRICAL EQUIPMENT PC 101 0000 42600 , ' 0 $24 17 $0.00 s�AFAIDBY>;{METIOD� -PAM s CHECK# f LT BYr >,z..�.��.*a ,RECEIPT# . Total Paid for`ELECTRICAL . •. $48 34 : $0.00 - DESCRIPTION-,,W� 'x H�*. ,h'x's.�'.: A000UNT ��, QT�IfF�j <i�". s AMOUNTS I'd _ az 4�p',a •�. � PAID )i ^7, %it it1.�;%J P�AIDIDATE_ u �3�"r::K`P• Y.......:4`d '.JR?iA<Sva`eBF>x `4 '+^«{.'i5 w; e,4 'o .�M+.'.': YbF "... .,• +4�»xx"&.�..✓, Y.? LY">.E`�r::lEW h. 1F: �W�$SF:ZxeA!71'u'?#h�i PERMIT ISSUANCE 1010000-42404, 0 $91 85 : $0.00 •- _ - ,f� ,.i i� k4Y c?%IV''r: LY'w .: rc }"rK `. PAIDBY� �g"$�' r'p'��;, 3 -. T'T�" r! -+v :METHOD xz'�y3 Y3Sft�# kF..c.),_,.5. - 13 'y >RECEIPT'#�q�• *yr{CFIECK# S` a' .k sr;Fr`fi`'.; 'tyR S."X'.b` "�CLTDRrBY" ri`g;g is'*.+.< . a: i...7a���af�ayY3�.w.T:S�.'.:isA54:L4+.y.Y.i.=asF�C.„vw. x7 riw„�4�3•a3C,w�h3a.eY.da.'iikC To tal Paid forPERMIT ISSUANCE $91 85 $000 . f !. .. Tom. ,.,. >. . ..a-sr4{, 'At . ♦ ,. -., .. r. � .,. a..n ^b o ... wi ..r....,....—...-... _`n ,we _. 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Y.'.r,. `s�nnn,,,m�Y��-r, 'Fr, .::,r,:m.i�.., „n..n xn m„nrmo�,'`m''kr,e�.....-.,��.,i.,.�;, 'iMx Mo • 1 • 1 NMI M • • 1 r e a l • •VER. :o • r Jffd -:..wn - ..... n ,..� 'E:• z, - rf„ ... �., u,d'. .. x' 4'-....k:i R,:n n'f n, r'r :'h r,,.:.3t,i ri a' ,ns�,� �S,dwi ,.µ::;aa sw`W� � of 'S• -,i � � "P"•��RiX '$"if',ff�1.-,�"i-3 : ��:: ��3<> ,..x.,' :x r . � ro s, ,e✓� .%� 2 ..,y, .. �.Y�'� . .� � , Vii„ ."x $'�s.� '�?,�"�" r _ z•. � �. x��'1 � .� � .f "^ia� ,5,t fiat' � x ,.R��<� t v a a� � r�N... •, ` .y,'d,, s�;z,: `w�>Q> �rw» �,, ,.Vi=a 7 ��s'..:7 ,is` � s 'i.S”" �:`c x'. "�'G•+r �.�..,.,, a � .•�� � 3 � t �:< ,�,�x�.�,>2w �.�� .FIN<1NCIAl�INF.ORMATION,t ;� � � :�� m.��-� ��-� � ,�>^ .�, �._ ,�. �- "Li,FtLa . :� �> '" � v., F: a.wr 'X,:.ao�'� t t �. �."^`^iP-' is , ,:.: n - a; .�'." ,; x, .+.'�._,;.iz _. s'rr3s��'� ;$,,; P • r ,'"'. __ __ CLTD..: DES CRIPTICIN ACCO UNT' QTY AMOUNT PAID PAID DATE RECEIPT # CHECK #,; METHOD PAID BY . B BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: OTHER ELECTRICAL 101-0000-42403 0 $24.17 $0.00 EQUIPMENT OTHER ELECTRICAL 101-0000-42600 0 $24.17 $0.00 EQUIPMENT PC Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:• •• PARENT PROJECTS _ BOND INFORMATION ........... . ATTACHMENTS Printed: Monday, January 12, 2015 1:54:33 PM 2 of 2 r SYSTEMS Iain •9/ Permit # Projcct Address: �l 4/6 , Cit y of 0 ,Quinta. Building.& Safety Division P.O. Box 1504; 78-495 Calle.Tampico . b Quinta, CA 92253-.(7.60) 777-7012 Building PeOW AMicagQ9 and,Trkkidk Sheet L �F/I; . Owner''s NameC l.aQ �/K Y A. P. Number: Address: S� l r 6,pL JL Pc�z %e— Legal Description: City, ST, zip: C aUL(Ntp Contractor:Telephone: __r �� T p Address: ; �`L8 3 � �•� Project.Deseripiion: City, ST, ZiP:. Ll 1P.611 .. K l 11 Telephone: (j'�'J?YQ 13. ..:••;•...::,::::;.;:,. ,;,::.:.,......;,.. Statc Lic. # : Z City,Lic. #: ?:5 -A Arch., Engr., Designer: Address: �r City., ST, Zip: Telephone: '�� P. -'' •>? " O ecu aneY ;Conslruction Type: :Tele Lic. #: circle one):-* New Add'n Alter Repairair -DemoState . ProJecthPa Name of Contact Person: r Lt �, Sq. Ft.:: #Stories: #Units: Telephone # of Contact Person: `ZU4 — fj6 .' 3S T J . Estimated„Value of Projcct: lJZ/0Y # Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE, , Recd TRACKING” PERMIT FEES, Plan Sets • Plan Cliccksubmitted Item Amount Structural Calcs. Reviewed, ready for corrections. Plan Check Deposit Truss Cales.Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction 'Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person - ;Plumbing Grant Dccd Plans picked up M.O.A. Approval Plans resubmitted Grading IN ROUSE:- '`' Rcyiew, ready for eorrcctionstissuc Developer Impact Fee Planning Approval • Called Contact Person A.I.P.P. Pub. Wks. Appr Date of.permlt issue School Fecs Total Permit Fees '...., ".,...-m �.. ..: .. i w .,':'x -. n..... e.. .. ., k. � - .m ... .. vim.. r. ::... r ., .. ..., �. _:. i ,�:., .:.� 4 - ... .moi.. m N .. . :Y . ". .:. -...-. ', ... t ,.. .: ....... .. .. :., .. � .e:. � �. , . '�:-r a I .. r .. .a.ni ..1-: �. - .. ..;. h. ..:..7 � .. :.: .. . n :.:. � ... .......... ... ,... ..... ... :.... a...... :.... � ... .. v .. ,.:F s..., n ... w .a.. vruP..ffi. ^ .� r .. ,... ...s .:...: .. ..... w_ ... ...� v.... �. . '.:. _.. ..,. n � � .w:txs, ... I I.. r �.. r., i. I. i I I ,. I.. i i '�. ', i I I: I I,: '.. I I '� i 1 J. i� i' '� i i.. I I.: I. I . I '. i I i I i i i i i �. I. i. �... I. '.,,I ''�' I i �. i i I.. I � i 1 I