05-1927 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
05.-00001927
52218 AVENIDA VALLEJO
APN:
773-223-024-13 -000000-
-Application description:
ELECTRICAL
Property Zoning: COV!E RESIDE 'AL
Application Valuation- 700
Applicant rchitect or Engineer:
W 2nF-PT
Cry UINTA
--tLAQ
I &c
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U S' CID C 0 S a
A I R. ECrRATI )N
U 3" ' '
I hereby affirm under penalty of perjury that III licensed�n, rTprcivisiDons I Chapter � (commencing with
t i Pro,
Sec ion 7000) of Div sion 3 .1 th ZBusiess a Pro essiopa s Pode, and my License is in full force and effect.
LicenseClass: C10- No.: 496913
la,4— Lq _05_� Contractor: A
OWNER-BUI DE DECLARATION
I hereby affirm under penalty of perjur at. I am exempt fro e 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, Oemolish:or repair any structure, prior to its issuance, also requires the applicant for the
p rmit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law JChapter 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. 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 ISec. 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
improvementi 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, as owner of the property, am exclusively contracting with licensed contractors to �onstruct 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 coniractor(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 herebi 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
Owner:
ESMELDA ZARCO
52218 AVENIDA VALLEJO
LA QUINTA, CA 92253.
Contractor:
RUDY'S-ELECTRIC
736 PALM
COACHELLA, CA 92236
(760)398-8039
Lic. No.: 496913'
VOICE (760) 777-7012
' FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/19/05
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WORKER'S COMPENSATION DECLARATION
I h�reby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -in ure 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
o a, or a pe ormance o a wor or w ic is permi s issue . y wor ers compensa ion
insurance carrier and policy number are:
Carrier EXEMPT — Policy Number EXEMPT
I certify that, in the pe r a ce of the wor or hich th s permit is issued, I shall not employ any
m VrrN--
so a
uld
rf
m
person in any marine so a to become s4biecito the workers' compensation laws of California,
and agree that, if I st ould ecome subjelt to/he workers' compensation provisions of Section
3700 of the Labor C )de shall Chwitfi pdrnply with those provisions.
DateS lq�05 Applicant:
WARNING: FAILURE TO SECURE WtRIERS' COM ENS TIO COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND VIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$100,000). IN ADDITION TO THE COST OF CO ENSATION, 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.
I . Each person upon whose behalf this application is mad ' a, 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 Quints, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. I
2. Any permit issued as a result of this application becomes null and void if work is not commenced
�QCOTIVOIL,
within 180 days from date of issuance 4 ion of work for 180 days will subject
uch permit, or cessat
permit to cancellation. *
I certify that I have read this application and state , h t t a above inf rm tion is correct. I agree to comply with all
city and county ordinances and state laws relating to bu Iding constr cti n, and hereby authorize representatives
of thi u t to enter upon the above-mentioned pr a y f inspe ti n purposes.
Date Signatum (Alplicantin Agent):
I LQPERMIT
Application Number . . . . . 05-00001927
Permit ELEC-SERVICE
CHANGE
Additional desc
Permit Fee 33.50
Plan Check
Fee
.00
Issue Date
valuation
. . .
. 0
Expiration Date 11/15/05
Qty Unit Charge. Per
Extension
BASE
FEE
15.00
1.00 .18.5000 EA ELEC
SVC <=60OV/<=200A
18.50
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Special Notes and Comments
- - - - - - - - - - - - - - - - -
- - - - - -
- - - - - - - - - - - - - - -
-UPGRADE ELECTRICAL SERVICE TO 200
AMP.
Fee summary Charged
---------- ----------
Paid Credited
---------- ----------
Due
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Permit Fee Total 33.50
.00
33.50
Plan Check Total .00
.00
.00
_00
Grand Total: 33.50
.00
.00
33.50