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10-0365 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: (:: i0`00000 65_ Property Address: 78110 CALLE TAMPICO APN: 770-020-005- _000000 - Application description: ELECTRICAL Property Zoning:• VILLAGE COMMERCIAL Application valuation: ,ice ram K' Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT 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 Professionals Code, and my License is in full force and effect. License Class: C10 License No.: 59 788 Date:L7��U7Cont ar .tor. G 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).: (_ 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 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.). 1 _ 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 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 Name: Lender's Address: - LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: CIRCLE K C/O TOSCO MARKETING CO DC17 P O BOX 52085 PHOENIX, AZ 85072 _ Contractor: K E M ELECTRIC 7375 DEEP CREEK DRIVE APPLE VALLEY, CA 92308 (760)247-7202 Lic. No.: 594788 Date: " 4/27/10 A?R 7 2010 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 STATE FUND Policy Number 1943128 _ 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 s all forthwithcomplywith t ose pro 'sions. . -Date: V/-;�7/�Qr"Applicant: •u- - " L 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 1$100,0001. 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 Director of Building and Safety 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 isnot 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 county to enter upon the above-mentionedpropertynspectian purposes./ /•J Date. 'Signature (Applicant or.Agent): •.Application Number . . . . . 10-00000365 Permit . .ELEC-MISCELLANEOUS Additional desc . " Permit Fee 15.75 Plan Check Fee 31.94 Issue -Date Valuation . . . . 0. Expiration Date 10/24/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00. .1500 PER ELEC DEVICE/FIXTURE 1ST "20 .75 --------------------------------------------------------- Special Notes and Comments ADD ONE 20A DISCONECT APPROVED PER S.T. Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ' Paid Credited Due Permit-Fee Total ---------- 15.75 00 .00 15.75 Plan Check Total 3.94 .00 .00 3.94 Other Fee Total 1.00 .00 .00 1.00 Grand -Total 20.69 .00 .00 20..69 LQPERMIT re Ox ................. ... ............. ------------ en -- N; .•............ - .._... o t aQf Ci r.......... ........... . - ------------ -- ------------ _._- ... = �..__...... .... P ........... &• flmrStmpMmber, C1 �C:..E 1ti L1 5 f Wb*r Waiinaiype: �� Rtdbu Cetluhr Cm wtivity R4AQv liwlical SA•up. AAdw4mal ream% [n:urum:ian tid'I'hlo M1laehlnc — Rti[!d (LtH) li mzm dFlm Attgll -4 Dedrrurod Or [fnSgtu l'ltnrbnw ` �� Addr�. g ! (0 Cai.l.E T A Mei CG tip. _ W �- u i A! TON C � LB Sr;-utl — Frutu He:3; Fiiu6s� � dHtu LxiW:A, Ueditu[al Oulln[ Cmb Step I nq46n9n M=&W a Cin•, 3;.ue: _ Al. Tloo Iadtap — ]light lAft 418m Rtp= FWaing Dodxaitd O ulo Sida..wlk 6telmw C., - e�-9 c Smra Men Niunbtr. S¢ue un-sa Nwjv F lbatw UTH ADA Cwopl:vm. .too ' Clumt Dtal-up DSL Stra�lU'1'tuet:Nsded( 5`li9 NO � EEutctim Co+ecr Ft I I�J L.•cut�ce 3amo W-eyor u„�l;G�,7�g1r1�\,.6A51i�^� Sketebo(: 1atctio7 �x[ulm D Describe .`nsga o[W.v►. 7M 5?t1taL. PO�.xr't- INtT Print Name and Ti[te redbax Location Auutowd DY %7 Bin # City. of La Quinta Building 8T Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 V Building Permit Application and Tracking Sheet Project Address: 7 �� ' /�� -Owner's Name: C) A. P. Number: Address: ` �C _ ; j. s Legal Description: tI -City I ; ST, Zip: i y�-� ��' S �:.;, Contractor: a Add ss: i✓ L red Telephone: -Project Description: `.?aZ City ST, Zip:U�Glt4171)" 3� d G�a DSS ww�c., Teleptione:94 Q� City Lie. #: State Lic. # : SCj N ? g Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lie. #: Name of Contact Person: $`: •' � ,. a: "::• Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft : #Stories: #Units: Telephone # of Contact Person: •-Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Plan Sets Req'd . ' Recd TRAt: MG Plan Check submitted PERMIT FEES Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cities. Called Contact Person Plan Cheek 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 Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionstiissae Developer Impact Fee Planning Approval Called Contact Person A,I,P•P• Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees