BELC2016-006678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE(760)777-7125
-FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/2/2016
Application Number:
BELC2016-0066
Owner:
Property Address:
77740 CALLE ORIZABA
WELLS FARGO BANK
APN:
658260001
P'0 BOX 13519
Application Description:
WELLS FARGO BANK / 200A SERVICE CHANGEOUT
ARLINGTON, TX 92253
Property Zoning: -
Application Valuation:
$2,000.00
Applicant:
Contractor: .
HEGGE ELECTRICAL CONTRACTORS INC . _
HEGGE ELECTRICA` CONTRACTORS INC
83852 AVE 45
83852 AVE 45
INDIO, CA 92201
INDIO, CA 92201
(.760)775-4855
Llc. No.: 748171
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 Professions Code,
and my License is in full force and effect.
License Class: C10 License No.: 748171
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).:
(_) 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.).
( ) 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 contractors) licensed pursuant to
the Contractors' State License Law.).
(� 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:
WORKER'S COMPENSATDN 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 3700of 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: HDI GLOBAL INSURANCE COMPANY Policy Number: EWGCC0002066
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 tha, if I should become subject to the
workers' compensation provisions of Section 3?00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant
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 ($100,00D). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOP. IN. SECTION 3706 OF THE.LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT .
IMPORTANT: Application is hereby made to ttv. Building Official for a permit subject to
the conditions and restrictions set forth on thi 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 tie 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 ofiissuance of such permit, or cessation of
work for 180 days will subject permit to cancelation.
I certify that I have read this application and sate that the above information is correct.
I agree to comply with all city and county ordnances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicam, or Agent):
Date: 9/2/2016
Application Number:
BELC2016-0066
Owner:
Property Address:
77740 CALLE ORIZABA
WELLS FARGO BAN t
APN:
658260001
P 0 BOX 13519
Application Description:
WELLS FARGO BANK / 200A SERVICE CHANGEOUT
ARLINGTON, TX 92.- 53
Property Zoning:
Application Valuation:
$2,000.00
Applicant:
Contractor:
HEGGE ELECTRICAL CONTRACTORS INC
HEGGE ELECTRICAL CONTRACTORS INC
83852 AVE 45
83852 AVE 45
INDIO, CA 92201
INDIO, CA 92201
(760)775-4855
Llc. No.: 748171
Detail: 200A SERVICE'CHANGEOUT ONLY. THIS•PERMIT DOES NOT INCLUDE RELOCATION OF SERVlCt. 2013 CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00 771
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0 _
$2.84
Total Paid for Credit Card Fee: $2.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES
101-0000-42403
0
$24.17
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
'0
$12.09'•
Total Paid for ELECTRICAL: $36.26
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85
Total Paid for PERMIT ISSUANCE:. $91.8S