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11-0519 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT ' BUILDING PERMIT Application Number: 111-00000519-'� Owner: Property Address: 51740 AVENIDA•VELASCOSCOTT YOUNG APN:' .773-134-011-11 -000000- 51740 AVENIDA VELASCO Application description: ELECTRICAL LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL. - Application Valuation: 1800 Contractor: i Applicant: Architect or Engineer: s MG LIGHTING & ELECTXII 73804 DINAH SHORE RI PALM -DESERT, CA�92 1 r I (760)770-5696 LiC. No.: 754764 VOICE (760) 777-7012 'FAX (760) 77777011 INSPECTIONS (760) 777-7153 Date: 5/19/11 IC f 4` ff r yon 1 n . �ez , JA14 ,.O -------=----------------------------------------- -------------------------------- ------------.--- - LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations: ' Section 7000) of Division 3 of the Business a90 Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Clas . C ns 754764 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is C tra 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 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 CA CONTR Policy Number 4503074 following reason (Sec. 7031.5, Business and Professions 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 employ any • construct, alter, improve, demolish, or repair any structure, prior to its issuance, 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; if I should become subject to the workers' compensation provisions of Section ` License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or _ of the Labor Code, I sh 11 it rov' that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 200 Vo any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001•: Date: t Ap cant: (_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL • Contractors' State License Lawdoes 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 ($100,000). 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 SECTION 3706.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.). - APPLICANT ACKNOWLEDGEMENT - (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and, restrictions set forth on this application. • property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.)• whose benefit work is performed under or pursuant to any permit issued as a result of this application, • (_ 1 I am exempt under Sec. , B.&P.C. for this reason 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. Date: Owner: - 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 - CONSTRUCTION LENDING AGENCY permit to cancellation. _ I*hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and. state that the above information is correct. I agree to comply with all ,. work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances.and state laws relating to building constru i 'an by author',pr olives ' of this unty en "r upon th ove-mentioned property for i �- � Lender's Name: • D e: -� Si ure (Applicant or Agent):• Lender's Address: LQPERMIT Application Number . . . . 11-00000519 Permit ELEC-SERVICE CHANGE Additional desc . ". Permit Fee 33.50 Plan Check Fee .00 'Issue Date 'Valuation . . .. 0 Expiration Date 11/15/11 Qty .Unit Charge Per Extension BASE FEE 15.00 1..00 18:5000 EA ELEC SVC <=600V/<=200A 18.50 Special Notes and Comments REPLACE EXISTING PANEL WITH NEW 125 AMP PANEL. 2010.CODES. -------------------------------------- Other Fees . . --------------------- . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 33.50 .00 .00 33-.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 ..00 1..00 Grand Total. 34.50 .00 .00 34.50 LQPERMIT Bin # City of La: Quinta Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # t - l l' Project Address: v '40. Owner's Name: A. P. Number: Address: -57/ ®�WK P Legal Description: Contractor: � �G �� C City, ST, Zip: 9 �a Telephone: Address: s Project Description: ' ©v City, ST, Zip: ' Telephone: , State Lic. # : City Lic. #; Arch., Engr., Designer: 42S Address: City., ST, Zip: Telephone: trz s'Y :;:.;..;<•�::..::.4:.: 5.,.:,.:::::: N<#t>:i:,V;v<.r>,><'<:•`:. c"n ........... ;;.;::;; Construction Type: yP Occupancy: State Lic. #: > Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Name of Contact Person: �o Telephone # of Contact Person: Lao) Estimated Value of Project. �— APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. 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 Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading . IN HOUSE:- M 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