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05-4497 (ELEC)4 P.O. BOX 1504 ^� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT �r Application Number: 0.5-o 0 97-" -` `' O Owner: Property Address: 53530 AVENIDA VALLEJO HUNTLEY RON APN:774-123-001-24 -000000- 51-001 EISENHOWER DR Application description: O ELECTRICAL Cl 0 LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL 0 Application valuation: 800 A, Fi��C�Q �oOs D Contractor: Applicant: Architect or Engineer: t�`p�T.� HEDGE ELECTRICAL CONTRACTORS P.O. BOX 1365 LA QUINTA, CA 92247 WCC: STATE FUND Lic. No.: C10 (r VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/06/05 - ------------------------------------------------------------------------------------------------ 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: - - - - -cense No.: C10 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -- - I ntractor:' DiL 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 -BU ER DECLARATION insurance carrier and policy number are: . I hereby affirm under penalty of perjury that I am exempt om the Contractor's State License Law for the Carrier 046111832005 01/01/06olicy Number 748171 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 3 0 of the Lab I s II?Oi hwith comp y with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by /yep "�D'ate:6 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: �/ 6 pplicant:-` - (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and `j 1 the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WAR N FAILURETO SECURE WORKERS' COMPENSATION COVER S 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.). - 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 Date: Owner: CONSTRUCTION LENDING AGENCY 1 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 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 thorize representatives of this county o e er upon the above-mentioned property for in poses. r� Date: 6 ignaturee((Applicant-&-Agent)) k TN Permit. . . ELEC-MISCELLANEOUS Application Number 05-00004497 Permit. . . ELEC-MISCELLANEOUS Additional�desc . Permit Fee 33.50 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 4/04/06 Qty Unit Charge Per Extension BASE FEE . 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18:50 - ------------------------------------------ Special Notes and Comments ADD 125 AMP SUB -PANEL & 20 AMP BREAKERS 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 - Bin 17.717 Permit # Project Address: 5 _53 A� A. P. Number: Legal Description: Contractor: Nli_ E ec. Address: 1 5a n v City, ST; Zip: Telepho LIU -7-75„(�t�C�C State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Tc6i; Telephone '# of Contact Person: �-71 # Submittal Req'd Plan Sets Structural Calcs. Truss Calcs. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed II.O.A. Approval IN HOUSE: - Planning Approval Pub. NIT''s. Appr School Fees 1 4 City of La Quin to Building 81• Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit APPlication and Trarkinlr ch.'Ar Lic. #: Z a �a157 1�_ 7 APPLICANT: DO NO Rec'd IF Plan Check submitt, Reviewed, ready for .Called Contact Pers Plans picked up Plans resubmitted 2"d Review, read)'. foi Called Contact Pers, Plans picked up Plans resubmitted Review, �eadv for Called Contact Pers( Date of permit issue Owner's Name: P, lU ht Address: 51 -60, EI I� City, ST, Zip: 922-53 Telephone - lo -Li( Project Description: ...............::::: - iiyd e A h! Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo 14 Sq. Ft.: # Stories: I # Units: Estimated Value of Project: 0.00 ..to F WRITE BELOW THIS LINE rRACKING PERMIT FEES d Item Amount corrections Plan Check Deposit in Plan Check Balance Construction 4echanical corrections/issue Electrical n Plumbing S.ALI. Grading corrections/issue Developer Impact Fee n A.I.P.P. Total Permit Fees