06-0092 (ELEC)P.O. BOX 1504. VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
,LA QUINTA;•CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT,
Date: _1/10/06
' Application Number: 1--,-o 6 00000092 t . ' Owner:
Property Address: �.2.54.5_.&V-ENI.DAj.VALUEJO MIGUEL GONZALEZ
APN: 773-292-013-1 -000000- 52545 AVENIDA VALLEJO
Application description: ELECTRICAL' LA QUINTA, <CA 92253 ►
Property Zoning: COVE RESIDENTIAL -------------------------- -----
Application valuation: ,1500 D
Contractor: f d
Applicant: Architect or Engineer: • Owner VAN
J -2006
•------------------------ ----- ciry
NA F QUINTq
- - NCE SEPT '
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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: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
Date: Contractor: _ 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 Policy Number'' .
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to I certify that, in the perform fice of the work for which this permit is 'sued, 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 s as to become subject to th workers' pensation 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, 4sh become subjecttothe kers' c pensation provisions of SectionLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codel or 3700 of the LaI shall forthwith comply ith th 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 (5500).: Date:Apjilicant
(' 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and s U
the structure is not intended or offered for sale (Sec., 7044, Business and Professions Code: The WARNING FAILURlEyT,O-SECURE WORKERS' PENSATI 'COVER IS UNLAWFUL, AND SHALL
,q Contractors' State License Law does not apply to an owner of property who builds or improves thereon,' SUBJECT AN EMPLOYER TO CRIMINAL PE ES AND C IL FINE P TO ONE HUNDRED THOUSAND
e and who does the work himself or herself through his or her own employees, provided that the _ DOLLARS (S 100,000). IN ADDITION TO E 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 OFTHELABOR CODE, INTEREST, ANDATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or 4 -
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seca 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 Licse 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 .
-1 71 of La Quinta, its officers, agents and employees for any act or omission related to the work being
- �-Dae
performed under or following issuance of this permit.k ti :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
CONS UCT N LEN ING AGENCY - -
- -- - - permit to cancellation. -
I hereby affirm under penalty of perjury that ther is a ons uction len ing agency for the performance of the - ` I certify that I have read this application and state that t ab a information is correci. I agree to c ply with all
work for which this permit is issued (Sec. 309 . C.1. - city and county ordinances and state laws relating to b din construction, and hereby authorize presentatives
• - of this county to enter upon the above-mentioned pro rt o�jnspection purposes.
Lender's Name: ff 77
Signature-IApplicantorAgenU:� 't+
Lender's Address: - / ��'�i' >rs-�t-+.' _. Y-r��%•r� y
LQPERMIT - - -
LQPERMIT
Application Number . . . . . 06-00000092
Permit . ... ELEC-SERVICE
CHANGE
Additional desc .
Permit Fee 33.50
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration -Date 7/09/06
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 200 AMP ELECTRICAL
SERVICE WITH NEW 200 AMP SERVICE.
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
LQPERMIT