08-1539 (ELEC)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777=7153
BUILDING PERMIT
Date: 9/09/08
Application Number:. 08-00001539 Owner:
Property Address: 53.745 AVENIDA CORTEZ- CURRIER JAMES W C
APN: 774-101-017-11 -000000- 53745 AVENIDA COR.TEZ
Application description: ELECTRICAL LA QUINTA, CA 92253 / 4
Property Zoning: COVE RESIDENTIAL
Application valuation: 3.000
• SFp 0 �
Contractor:
Applicant: Architect or Engineer: MD ELECTRIC Q; oo
PO BOX O
CATHEDRAL CITY, CA 92234
(760,)327-5024:
/ -------------------------------------------------------------------------- ---------------------
M `/^ Lic. No.: 756947
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyof perjury.that I am licensed under provisions of Chapter 9 (commencing with I herebyaffirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Businesses Prof%ession s�Code, and my License is in full force'and effect. _ 1 have aridwill maintaina certificate of consent to self4nsure for workers' compensation, as'prbvided
License Cl : C10 'cense No.: 756947 for by Section 3700 of the: Labor Code,ifor the performance of the work for which this permit is
issued.
e; ntractor: 1'.have and.will maintain. workers' compensation,insurence, as required by Section.3700 of the Labor
Code; for the, performance'of the work for which this, permit is issued. My'workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 2290.025870
following reason,(Sec. 7631.5, Business and'Prafessions Code: Any city or county: that requires'a permit to _ I certify that, in the performance of the,work.for which this permit is issued, I shall not eniploy�any
construct, alter,.improve, demolish, or,repaic.any structure, prior to itsissuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file.a signed 'statement that he or she is,licensed pursuant to the. provisions of the Contractor's State and agree that, iflahewWkecome.subject to the workers' compensation, provisions of Section
License Law (Chdpter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or W�;fp—ptl'l
e Labor Code, 1 s_ II fort ith comply with those.provisions.
that he or she'is exemputherefrom.and the basis for the alleged exemption. Any violation of Section 7031.5 by 11
any applicant for a.permitsubjects-the applicantto a civil penalty of not more than five hundred. dollars (55001.: ate:cent: _
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec, 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL,
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN'EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE'HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the, DOLLARS (9100;0001. iN ADDITION TO'THE COST'OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,, however, the building•or improvement is sold within SECTION37O&OF THE LABOR CODE; INTEREST, AND ATTORNEY'S.FEES.
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.).
f _ 1 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 acontractor(s)-licensed
pursuant to the Contractors''State License, Lawes.
(,_ 1 I am'exempt under Sec. , B.&P.C. for this reason
Date;
Owner:
CONSTRUCTION LENDING AGENCY
I herebyaffirm'under penalty of perjury that: there is a construction lending agency for performance of the
work for which this permit is issued (Sec. 3097, Civ. C-.).
Lender's Name: ,1
Lender's Address: P
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Applicatiomis hereby made to the Director, of Building.and Safety for a permitsubject to the
conditions%and restrictions!setforwon 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 Ouinta, 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 1SO'Aays from date of issuance of such permit, or cessation of work for 180 days: will subject
permit to cancellation.
I certify thatl'have read',this applic d state that,the above information is correct. I agree to comply with all
city and county ordinances-erid'state;,laws - at,
to building construction, and hereby authorize representatives
of this county en on the above
red property Porins e�tion purposes.
D _ ature'(Ap canto Ag_ ): _
., :;
Application Number . . . . 08-00001539
Permit . . . ELEC-SERVICE
CHANGE
Additional desc . .
Permit Fee . . . . 33.50
Plan Check
Fee
.00
Issue Date . :
Valuation
. . .
. 0
Expiration Date . . 3/08/09
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
-----------------
p -------------------------------------------------------------
Ses and Comments
CHANGE OUT EXISTING 100 AMP ELECTRIC
PANEL FOR NEW 211 AMP PANEL.
Fee summary Charged
Paid Credited
Due
---------------------------------------
Permit Fee Total 33.50
----------
.00
----------
.00
33.50
Plan Check Total .00
.00
.00
.00
Grand.Total 33..50
.00
.00
.33.50
LQPERMU
TO/TO 39Vd 1d3U MIB d1NIM VI TTBLLLL09L 99:80 800L/68/60
City of La Quiuta
SuUdbl� at Safety Dhiman
Permit 0
P.O. Box 1504, 78-495 Cade Tampico
La OWMU, CA 92253 - (760) 777.701.2
Building Permit Application and Tractdng Sheet
Prq cd A4&u&
e co Owaex'a Ntettc: b�
A, P. Number:
Address:Z
e..
Leal DoCrOdon:
City, ST, Zip: 02,j
Contrauor:
Tom:
Addras:
hq' pct Dcwipilon.
City. ST. Zip: '
dL�
C Z l� ^ T� VL
Su to Lic. 0 : 7,16 C1117
City Lic: #:106 7
Arch., Engr., Designer.
Address;
City. !M. tip:
Telephone:Coust
uction Type:: Oompanry:
State Lic. P:
ect type (ciock one): Ncw Add'n Alter ttcpair Demo
Now of Contact Person:
Z9q.E't.: N 5mnies e., 1 R Units:
T'et4ftf o N of Contact Person:
Estimated Vase of Projoct y
AFMCANT: 00 NOT WRITE BELOW THIS LINE
d
aeqId
Heed TRACKMG PKR)AT FESS
Plan Sets
Plata Cbt& submIM4 flew Amount
Strrettrrd(�kr.
ReNewed, ready ivy eterrexdoos
Plsa C'aedt Dcpadt
Tress Cates.
Called Coataet Pw"o,
Piss Cbe& Balsoce
Eu=V Cak&
Mas Pdmd up
Coostraetio�
Flood plain plan
Plans reoWited
Mechanical
Gi"Ug Plan
2" RevicN. ra*'for torregfigmAmc
f lean"
Subeentaetor Lin
Ctnod Contact Penon
"%kRb6g
Grant Need
Plans pidwd up
ML
HAA. Approval
Pleas resabmined
Grading
WHODSE.-
*' Herirw, rady for cerreMouMmue
Develops: lagwt Fee
Planaft APprovw
Craned Conues Person
A".P.
Y,b. Wim. Appr
Dak etpormit ivae
School Bees
Total Perotit fees
TO/TO 39Vd 1d3U MIB d1NIM VI TTBLLLL09L 99:80 800L/68/60