BELC2014-1016LICENSED 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: _ License
No.: :LIC -0105320
q3- 2 (f`Z� 7 Contractor: �/ , //� 01`l�
�'Date:
OWNER -BUILDER CLARATIO
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 alles�fd
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 contractor(s) 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 Na
Lender's Address:
(760)831-0660
Llc. No.: :LIC -0105320
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: _ Policy Number: _
_ 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.
Date:S_2C0_w(C/ Applicant / re /'/MA & -I
WARNING: FAILURE TO SECURE WORKERSCOM SATIOCOVERAGE 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 Building Official 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 city to enter upon the bove-
mentioned property for inspection purposes.
Signature (Applicant or Agent) ��%
VOICE (760)•777-7125
78-495 CALLE TAMPICO
D
l
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT V INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/26/2014
Application Number: BELC2014-1016-
Owner:
Property Address: 78755 NOLAN CIR
1ANICE CARPENTER
APN: 604233021
78755 NOLAN CT
Application Description: PANEL CHANGE OUT 125 TO 200 AMP
LA QUINTA CA, CA 92253
Property Zoning:
Application Valuation: $2,000.00
Applicant:
Contractor:
HARTMAN ELECTRIC INC, GREG
HARTMAN ELECTRIC INC, GREG
77849 CALLE ARROBA
77849 CALLE ARROBA
LA QUINTA, CA 92253
LA QUINTA, CA 92253
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: _ License
No.: :LIC -0105320
q3- 2 (f`Z� 7 Contractor: �/ , //� 01`l�
�'Date:
OWNER -BUILDER CLARATIO
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 alles�fd
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 contractor(s) 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 Na
Lender's Address:
(760)831-0660
Llc. No.: :LIC -0105320
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: _ Policy Number: _
_ 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.
Date:S_2C0_w(C/ Applicant / re /'/MA & -I
WARNING: FAILURE TO SECURE WORKERSCOM SATIOCOVERAGE 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 Building Official 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 city to enter upon the bove-
mentioned property for inspection purposes.
Signature (Applicant or Agent) ��%
FINANCIAL •• •
`ACCOUNT QTY AMOUNT
"PAID
PAID DATE
DESCRIPTION ° '`
BSAS SB1473 FEE
101-0000-20306 0
$1.00
$0.00
,.., PAID`BY t f , '_
'S, ;METHOD �^ y,�� p3 RECEIPT #;'z
CHECK #*
CLTD By..
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION,s " ' v
6'4 6 '`_ ACCOUNT '�-°
QTYT
, AMOUNT
PAID
"PAID DATE
SERVICES
101-0000-42403
0
$23.83
$0.00
.. PAID BY
METHOD--'
:.RECEIPT #
CHECK #
CLTD BY
"DESCRIPTION
ACCOUNT :
QTY
.; -AMO U.NT•
PAID'
PAID DATE
SERVICES PC
101-0000-42403
0
$11.92
$0.00
r .? PAID BY
<� METHOD '
�, RECEIPsT #
CHECK #
CLTD BY:
Total Paid for ELECTRICAL: $35.75 $0.00
•DESCRIP,TION ,.
<<ACCOUNT -°
QTY.
AMOUNT',
PAID ''
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$90.57
$0.00
PAID BY •
METHOD
RECEIPT.# L
CHECK # ,.,
CLTD BY
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
TOTALS:00
Bin #
.City of La Quin ' ta
-Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760)-777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: '7976 S 0 o (o -,.,C 1 r.
'Owner's Name:
A. P. Number:
Address: 9 =1= rz j ,--r '7 7 -,s S /Vo ov,
Legal Description:
City, ST, Zip: 4A 2 2- `
Contractor: &f-,, C_
Telephone: 7(o0- ��Z[ OCDCP
Address:
Project.Description:
City, ST, Zip:
e*_ 0"J.
Telephone: '7 GO fS 3 1 — 0 G G
L
k) i k( 6e t_,p 'e -di -k
State Lie. # 9?57
City Lie. A..
_!v
V
Arch., Engr., Designer: %
Address:
City., ST, Zip:
Telephone:
. .....
Construction Type: p c+,r.,- Cr: 0 ccupancy:
Project type (circle one): New Add'
Pjn Alter Repair Demo
State Lic. #:
Name of Contact Person: GGr,,* fzJ -
Sq. Ft.:
# Stories:
# Units:
Telephone kof Contact Per -son: 'Sc)a_— -7 3' _791SR'TEstimated
Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal Rcqld Rcc1d TRACKING PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss C21CS.
Called Contact Person
Plan Check Balance.
T.ItIc 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
F Grant Deed
Plans picked up
S.M.I.
H.O.A; Approval
Plans resubmitted
Grading
IN HOUSE:-
3" 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
Total Permit Fees
j I Y".
Permit Number: BELC2014-1016
Applied: 8/26/2014
Issued:
Status: SUBMITTED
Parent Permit:
Parent Project:
Approved:
Finaled:
Description: PANEL CHANGE OUT 125 TO 200 AMP
Site Address: 78755 NOLAN CIR
City, State Zip Code: LA QUINTA, CA 92253
Applicant: HARTMAN ELECTRIC INC, GREG
Owner: JANICE CARPENTER
Contractor: HARTMAN ELECTRIC INC, GREG
Details:
ELECTRICAL PANEL CHANGE OUT UPGRADING EXISTING 125 TO 200 AMP PANEL PER 2013 CALIFORNIA ELECTRICAL CODE.
Printed: Tuesday, 26 August, 2014 1 of 1
4J�YVSYSTEMS