13-1064 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
.LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001064
Property Address: 78725 LA PALMA DR
APN: 604-172-008-129 -23269 -
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1150
Applicant:
T4ty", 4 44"
Z��
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury t t I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bus, s and Professionals Code, and my License is in full force and effect.
License Class: C10 License No.: 865801
,ate:�rCetStractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjthat 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
any applicant 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.).
(_) 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 contractor(s) 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
Owner:
PATRICK CHARRIONS
78725 LA PALMA DR.
LA QUINTA, CA.92253
(
Contractor: D
HOFFMAN ELECTR
40 N. ALTADENA
PASADENA, CA 91
(818)306-7313
Lic. No.: 865801
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
L�
- X00 2'21093
QUINTA
DEPT.
Date: 8/22/13
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 TOWER INS Policy Number WCC7019008
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner o as to become subject to the workers' compensation laws of California,
and agree that, if I s . d become subject to the workers' compensation provisions of Section
3700 of the Labor ode, I s rthwith comply with those provisions.
r
Date: ,- I Applicant:
WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 ove information is correct. I agree to comply with all
city and county ordinances and state laws relating to build' g construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propert for inspec 'on purposes.
(/Signa urt (Applicant or Agent):
LQPERMIT
Application Number . . . . .
13-00001064
Permit . . . ELECTRICAL 2013
Additional desc .
Permit Fee . . . . 23.83
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 2/18/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC POWER APPARATUS
23.83
-----------------------------7----------------------------------------------
Special Notes and Comments
ELECTRICAL - PANEL CHANGE -OUT.
2010
CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . .
BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, ELECTRICAL
23.83
PERMIT'ISSUANCE M/P/E
90.57
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 115.40
.00 .00
115.40
Grand Total 139.23
.00 .0.0
139.23
LQPERMIT
Btn.
Perinlc #
' 1
City of • La Quin to
Building U Safety Dtvfsfon
P.O. Box 1504,•78-495 Calle Tal ICI
La.Quinta, CA 92253 -•(760) 777-7012
BUIlding Permit Application and Tracking Sheet
Project Address: 70%2-5 LA
WU0, ' ►r, Owner's Name:. I Oil r.iCK lilt(it rrl ��tS'
A. P. Number. (90q— L'1 �:. OQ Address: 19-1 a5 La PO-jMQ, p r•
Legal Description:
City, sT, zip: L•� QtM /L"ta (iR Q 22-5 3
Contractor.a (� L Telephone
Address: uC) IV d�,j'1 Dr. S 20 Project Description:
City,ST,Zip: Pasadena CA 61110" S l i1 j
Telephon : Jo10'1313
State Lic. # : • vQ 5 0 i
Arch., Engr., Designer.
City Lie. 9,
Address:
City., ST, Zip:
Telephone:
State Lie. #:
LL"�
Construction Type: � er-+Y` Occupancy:
Project type (circle one): New Add'n Alter Repan Demo
Name of Contact Person:
Sq. Ft.: # Stories.
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
is Submittal Re 'd Recd TRACIMG PERMIT FEES
Pian Seta
flan Cheek submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Pian Check Deposit, .
'Frust Casa.
Called Contact Person Plan Cheek Balance,
'rifle 24 Cates.
Plans picked up Construction
Flood plain plan
Pians rrsubnilfted • Mechavileal
fi'rading plan
Z" Review, ready for eorreetionelissue Electrical
Subcontattor List
Called Contact Peraoa lzlun►bing
Grant Beed
BIG. , Approval
M HOUM .
Piaui picked up S,M1
Pians resubmitted I Gfxding
14 Revlew, may for correedonsAflue Developer Itapiet Fee
Planning Approvat
Person A %Po1j.
@ub. mils. Appf '
gate of permit [stud
Wool Feet
Total Permit Fees