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11-0729 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4t!t 4 4v Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011: INSPECTIONS (760) 777-7153 Date: 7/05/11 C,App1Gc t_10mNumbgr. _11-0000.0729 Owner: Property Address: 78130 CALLE TAMPICO HIGHLAND 'LA QUINTA II LLC APN: 770-020-012- - - 80 S LAKE AVE STE 660 Application description: ELECTRICAL PASADENA, CA 91101 Property Zoning: VILLAGE COMMERCIAL Application valuation: 1200 A n Contractor: Applicant:Architect or Engineer, LI f CHOICE ELECTRICAL CONSTRUCTION 3195 REDHALL AVENUE, SUITE D u ) COSTA MESA, CA 92626 2�i1 i (714)556-5684 Lic. No...:811811367 1 - �1 F•'q� LS: � v" ------------------------------------------ \-.�----� ---------------------.----------------------- -- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I 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 and 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 Class: C7 C10 License No.: 811367 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is w ^ issued. _.Contractor: ��/r' \ •`— _ 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 TRUCK INS Policy Number A09247531 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ 1 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 / 3700 of the Labor Code, I shall forthwith c mpl wnh those provisions. 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)•: ` _Date: �"/— l �ApplicanCJ 6 (_ 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 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 ($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.). (_ 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 contractors) licensed pursuant to the Contractors' State License Law.). ( 1 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 044 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 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 county to enter upon the above-mentioned property form ection pu oses Date -Signature (Applicant or Agent): o Application.Number . . . 11-00000729. Permit . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 15.75 Plan Check Fee 3.94 Issue Date Valuation 0 • Expiration Date,. 1/01/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 --------- - - ------------------------------------ Special Notes and Comments RELOCATE EXISTING ICE MERCHANDISER CIRCUIT TO NEW LOCATION. - - -- -------------------------------- 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 Bin # Qt! of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pe f # "I Project Address: '7:'!30 c L4 F T�4tnP% �e O Owner's Name: A. P. Number: Address: a //9,9 ?/f4 K F,,(/fef— $(Mrjg Z o o Legal Description: City, ST, Zip: 411VZV (:!/r �+ Contractor: P814 d go ICf, �i: �C7�/�G { ��j:;u�+;k;:fiA is :�:L:; Ji':i iii}{'Y:•fi•:; Telephone Address: Moo Af ' /4 L 4dg— 54 17A Project Description: City, ST, Zip: C a5T 4 Telephone: 5Z iii $ �:.. r• i40 ��,:,::>:«:>:: State Lic. # : ' — 3 9 City Lic. #;( 15 -�� _ —' . 4— QWArch., Engr., Designer: Address: City., ST, Zip: Telephone: P State Lic. #: €`ri>< # ? ° ::::<::>':•''.::: XX »: ::#;::<;;:::;<;f:: < z> ::> >>..K" >;s::>::s;;•<>:; < Occu anc Construction Type: f ` ?,Q��(� p y Project type (circle one): New Add'n .Alter Repair Demo Sq. Ft.: # Stories: # Units: Name of Contact Person: Telephone # of Contact Person 70 a,' -�5-3 3 Estimated Value of Project: d v APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Tide 24 Coles. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20° 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 correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 917411