13-1072 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001072
Property Address:
54260 AVENIDA VALLEJO
APN:
774-245-001- - -
Application description:
ELECTRICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1200
Applicant:
/ ^�-- VOICE (760) 777-7012
_,C�_ Of aw (KuwajFAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT . INSPECTIONS (760) 777-7153
BUILDING PERMIT
Architect of Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I!4
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: -! License No.:
��
Drat/e: Contractor:
U �
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
aq�
pi
for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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.).
as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
'� 1 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 confractor(s) licensed
/ pursuant to the Contractors' State License Law.).
tt���+✓�������/��f1(((
I am exempt exe^mp't _under Sec. , B.&P.C. for this reason
wrier:
Date: •`
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 ISec. 3097, Civ. C.). .
Lender's Name:
Lender's Address:
LQPERMIT
Date: 8/26/13
Owner:
BECERRA ADOLFO H
RR 3 -BOX 21
MARIETTA, OK 73448
------------------
u
Contractor: ,f7 2,62013
Owner
Cl1'y OF
' FIIyg1V QUllyrq
-
--------------------- ----- CF_oeer
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 Policy Number
_ .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 shall forthwith comply with those provisions.
Date:. Applicant
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 ($100,000). 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 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 c nstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property f inspection p rposes.
Da�ignature-(Applicant or Agentl: .�
Application Number . . . 13-00001072
Permit . . . ELECTRICAL 2013
Additional desc .
Permit Fee 23.83 Plan Check Fee
.00
Issue.Date Valuation .
. - 0
Expiration Date 2/22/14
Qty Unit Charge •Per
Extension
1.00 23.8300"EA ELEC SERVICES
23.83
Special Notes and.Comments
ELECTRICAL = REPLACE ELECTRIC PANEL BOX,
AND RISER. 2010 CALIFORNIA BUILDING
CODES.
t
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
.1.00.
PERMIT.ISSUANCE M/P/E
90.5,7
Fee summary Charged Paid Credited
Due
Permit Fee Total 23.83 -.00 .00
23.83
Plan Check Total. .00 -.00 .00
..00
Other .Fee Total 91.57 ) .00 .00
91.57
Grand Total 115.40 .00 .00
115.40
LQPERMIT
nuu-at;)-CVJ1J 14:wa rKU1'1:VU!6IHL UUNNECTION 7605642699
TO:15802764281 p,2/3
Rif) #
.�
City of La Quinta
9ulldfrlg 8T Safalty Dtvlskn
P.O. Uox 1504, 70.495 Calle Tampfca
PeIt #
ILI
b Quanta,CA 9.2,253.(790) 777.70:1Z
�/
! Building Permit Application and Tra '{dna Sheet
rrnj4otAddress- 2ra—a L,lj 0477)b )b
owner'sNnme:
A. P. Number: -
Address:: r .. 12,
Leal T?ercrtptfan:
City, STo 7.ip;
Telephone: l
r: : b
f s
Coatraotor;
Addrea:
Project Description:
'City. ST, zip:
`
r
Telephone;
jv i
State Lio, l) :
easy Lac- rf,
Arch., EnSr., Designer..
EL Lai powx&U
Addrosss
,
city, ST, zip:
Tolephoae:
s
Construction Type: (kaupan.Cy:
pr0jMt type (etrela anc): New I Add'n Alter R6p' alr D=o -
Sante Lir A: `M
e>... x
Numa of oantuct parsons
Sq. pk ; NQ
SStorigs:
tEUnits:
Tol hone 0 of Contact i�etsvn:
— r—j T;stimated Value oP Projorn
APPLICAhrP: Oq NOT WRITE BELOW THIS LINE
q
Jut mittal
Req'd
Reed
TRAM NO
PERMIT FIERS
Pilu &U
Finn Cnaok oubmitted
Itenj
Amount
tatraeror■1 C■ren,
Replcsvd, ready Or eorreellons
plan Check Deposit
Tawas Coles.
Called. Contaet!( man
C l� Cbeek 11■laneA,
Title 11 Cates.
plans picked no
CodKrncdaa
' Mana plain pian
rune reeubmlttee
McSkantc■i
Gradlne pioq
2" Ravlow; ready ror corrolioulAuuc
Eleotric■{.
Sub4caUctor Lill
Called Contact Person
Ptoinblog
Grant Dead
Alnn>:.pickrd up
SAL
N.O,A Approval
Pionsreaubdtittco
t3,■iiing
IN MOUSE,
"" RevIew, ready for carretliotu/isane
Dav4oper Impact itco
Punning Approval
Called ConiuCt r arson
Pub- WIM. Ar'pr
b■rc orper ult Irlac
School Fees
i
'I'ot�t l'Crmft Fto�
AUG -26-2013 14:48 FROM:POSTAL CONNECTION
F.t). 60X .1504
7605642699 T0: 15802764261 P.1/3
LAAl QurNTA, CALIFORNIA 92247-1504
78,495 CALU! '1'AMOCO
LA QUJHTA, CALIFORNIA 922S3
OPERTY OM NRR"
1 6VOING & SAFETY DEPARTMENT
(760) 777-7012
PAX (7460) 777-70t t
Disclosures &• !forms for Owner -Bonders Applying for Construction Permits
Dear, Property Ow a' r,
An. alspliemdoen fon a building pnrtbit bas been subuliucd in )qui name .Listing youlrself as the builder of the •prowny
imprlorresneexta spocificd at �- — ti
W'e arc fft*idiug you with art OWWAlauiider Aclmowtedgauutt and L tics Vesi"tion Form to make you aware of your
mbilities sad possible 4t& 'yo, may incur by haying tb iv permit issued in your uuk as the
Owner. BuiWrrr. We will arse'lasue a btdlding ptrmtt ttutll ru have road, lWtt&W your andcstan ding of oa ck p"Asion,
signed, and returned thio form to us at our articlal address latueated, An agent or the ow= cansw. cxeeuft Ili $ noticc
unless you, the property owner, obtain the prior approval of tete pmnitting authority.
WROMTOM. Brad ands iri[ial emb scrsremsnt below rd atgnlfy you'7n' erstarrd Or vetrfy dins itfonrt atL
-1 understand a fft4uczlt practice of unliceascd persons is to have the prop4ty owner obtain an "Owner -Builder"
building permitthat ermnooyaly implies that the property owner is La''OVj&ng his or her own labor anal tttstteritd personally. 1, as
an Qwner-Builder, may bc hold liable and arnbimt to serious fimotal rink for any igju}ries susuined by .an uu6censw potsort
and izis or her employpcs while ;wow on my property- My hopeowner s iosuram�c may not provide covtrW for those
WImm t alts willfully actingins an Owner -builder and am aware of the limits of nay iojruarsCetovrrage for iWurics to work=
on sly prosy.
- I understand building permits are not rogairsA to be sigtwd by proLcvty owuers unless they are responslble for the
eomtruction apd are not hinue a Licensed Contractor to assume this responsibility.
I understand ns an "owner-Bgildet" I nm the reapb.,sible party of record on the pormit..t un&mtm d that l may ptotoot
mysclffroat potential finauc4l. tisk by bitift a licensor Contr+mctor and Loving the pernilt tied in his or bar napte instead of my
Own,
JMM - I undastaAd Contractors 4r`a squired by taws to be licensed "d bonded in Crdifotnia and to list their liceast numbers on
permits and corntncts.
l ur:derstanQ if ! c�rploy or olherwi c engage any persons, other that► Californiai l iccnscd Contmotors, and the total value
of my construction is at 1casE five hundred dollars (S500), includutg labor and rutar Ls, I may be considered an "employd'
and state au iEdr+nat law,
�. l undot•sUVW if I am considertid an ` l '
scup oyer' under state and Woral Law, t moat register with the state and frdcrat
govcrutucnt., withhold payroll taxes, providt: wOrkcre ebmpensation disability ins ' c, and contribute to unemploynteat
f7,
ttstttiun For cach'bntploycc ' 1 also uudetstand eny failureto abide by these 1 ws may subject me to serms financial
1 understand under CWifbrnla Contractors' State Liccaft:.•aw, an ()waer-Builder who builds single-family tratidontial
structums cannrrt legally build them with tbo intept to offer them Fur s;alc, unlCss all work is performed by licensed
svbcontmctors and the rrumb;cr of structures does not oxotod four within any calene'ar year, or all of the worts is performed
under conkuvt with a licensed general building Contractor.
HUU-eb-eU1,5 lq:4y FRUM:POSTAL CONNECTION 7605642699 T0:158027s4201 P,3/3
/ S. I understand as owner-)juildcr if t scll the propccry for wbkh this permit is iwmcd, I may be W4 liable for any
financial or personal. is WV3 sus od by . Y subseQuemt owner(a) drat result from; any latent cotutruction oeftcts in 1c
workmansbin or materials; ,
/60, 1 understand t t �
y o lain, more infation mgarding my obligations as rta 11etoploye, from tlrb lar rn d Ravenun
Service, std United Stat S F3usiness Adrriinisttmion, tlto• Califotnia Depamnent ref emofit Paymt+uts, and the Cattruraid
DIVISIotI of Irrductrial Accidents, l also understand 1 mby contact the Calrfornio Coutractore State LSoem Board (CSL$) at t-
300732'1 �CSLR (2752) or :w+ww.cxih,ca.gov for mnrt Information armut I leensed contractors.
00 - I am aware of anti e04=t to an Otivrter-Builder building permit applied for iti my nate, and understand that 1 am the,
party legally azsd fittaneially nzlp z eiilla •for proposed consauction activity at fife fallowing addre4a;
Oji�tl. l agog that, as die patty tatty and i"utaoeiallyreap ' ible for this posed consttucUvtq activity, l will abi& by all
appl�laa tr laws and requirotr m% that gov= OtMtterti}lluildcrs as well as atnploycrs.
r1 Z. rree to
erg natifytlte issuer of this form ttnmodiately of any tsdditlous, deletrgma, or cbArtges W any of the informatiW I
1tavo provided on this form Gcettatd-contractnrs aro ktgulated by laws designed topotoct the public. If you emittttct with
aotrreorm who dons wt hrive a! limgtac. the Coarse 0W State LkCIMBoaM truly be tenable to &*atyou with any Eittwl&W toss
You may sustain as a tnswt of a complaint your only rentedy against "ceased Contractors tarry bo iu:ciYil ooart, U i= also
4mpprt 0 far you to: unfit rstand.tlrat.if an aulioemo Contractor of employee of that individual or firM 19 lnjurad wkk wmrkimg
on your Property, You "Y be held moble ,tbr dw4agm if you obutin a permit as Ottrr�er.Builder and wait to-hixt Ooifnrgora,,
You will be ft*oasible. f0 ye*irrg whttft+raF.o not those Cowmctotts an grvpaty liccnmd and dm status of thsic vvodtVW
eompearadion iaaurmoe ooverago.
I
lletorr Y building pert"It C" -W kned, this foray must be completed sad signed �y tbo property owner a"retwmtdt to
the agency respondbie [or ww":0ke pet -ml sorer d copy of 4op"p6►v'0wnees-dovor'sawf%xi; form bKi of
arhrrr Ker�jicaQCoa aecepitrblq to Ad 49"ey is mqw�vd to be prarsntcd Wren tk /reirrrrit is r sun Fa miJj' the prVaV
owner's sigrcrure.
Signantre ofprYrperty owner Date '
Neste; Ae following.40torization Forst is required to he completed by tha property owner only when dittignating
an agent of the property owner to apply for a Construction Permit for the OKcr-Duitde:
UrrUrVRIZATION d ACENTT0 ACT ON MFfM'i
rxciudrtig the Notscc to Property ower,aw C"wtiou of which i Wt&bMt4Ad is ray
the fo!lowrrig pemc►rr(a) to act as my ageept(s) to apply for, sign. and file• the doctrmer
Permit foil my project
Scope ofConstmctioa Project (or Aesctiption of Work)- i CG42
Project Location or Addr*;
Natnc of ,authorized Avert'
Addrm of Authorized,
I declare under penalty o
.infonnat'ion and certify ii
gweprable'to the agency
Property Owner's Si
raomi CCspooaihility, I hereby'autiwrize
neuc *ary to obtain an Owoer-Builder
porjttry that I am the property owner for the address listedlabnvq and r petsoaAlly Med out doe above
nccumcY. *010: Acopyofthe mmer�'s-driver's Keene, foinr notarization, or other verf"ion
S Mquired tv be sMied when the permit is issued to varify the propmV owner's signature.
pate; :Gly l l