BELC2017-0021LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my Licenses in full force and effect.
License Class: C10 License No.: 748171
Date: Contractor:
WORKER'S COMPENSPTION DECLARATION
I hereby affirm under penalty of perjury one :)f 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:
OWNER -BUILDER DECLARATION
Carrier: HDI GLOBAL INSURANCE COMPANY Policy Number: EWGCC0002066
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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
4.4Qulitz-
VOICE (760) 777-7125
78-495 CALLE TAMPICO
0
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
FAX
FAX (760) 777-7011
LAQUINTA, CALIFORNIA 92253
DESIGN "& DEVELOPMENT DEPARTMENT
(760) 777-7153
�*
BUILDING PERMIT
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) 1, as owner of the property, or my employees.with wages as their sole
Date: 3/6/2017
Application Number: BELC2017-0021
ONE HUNDRED THOUSAND DOLLARS ($100,Cb0). IN ADDITION TO THE COST OF
Owner:
Property Address: 56259 WINGED FOOT
apply to an owner of property who builds or improves thereon, and who does the work
KIPP DOWNING
APN: 775310001
56259 WINGED :OOT
Application Description: DOWNING / INSTALL (1) 240V 60AMP TESLA WALL CHARGER AT GARAG-
LA QUINTA, CA 52253
Property Zoning:
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
Application Valuation: $500.00
1. Each person upon whose behalf this appication is made, eacFi person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
Applicant:
State License Law does not apply to an owner of property who builds or improves
Contractor: .
HEGGE ELECTRICAL CONTRACTORS INC
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
HEGGE ELECTRICAL CONTRACTORS INC
83852 AVE 45
(� I am exempt under Sec. B.&P.C. for this reason
83852 AVE 45 :
INDIO, CA 92201
2. Any permit,issued as a result of this appication becomes null and void if work is
INDIO, CA 92201
not commenced within 180 days from date cf issuance of such permit, or cessation of
Date: Owner:
(760)775-4855 _
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and ;tate that the above information is correct.
Llc. No.: 748171
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my Licenses in full force and effect.
License Class: C10 License No.: 748171
Date: Contractor:
WORKER'S COMPENSPTION DECLARATION
I hereby affirm under penalty of perjury one :)f 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:
OWNER -BUILDER DECLARATION
Carrier: HDI GLOBAL INSURANCE COMPANY Policy Number: EWGCC0002066
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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner sa as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
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
Date: Applicant:
permit subjects the applicant to a civil, penalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) 1, as owner of the property, or my employees.with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,Cb0). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
orherselfthrough his or her own employees, provided that the improvements
_himself
are not intended or offered for sale. If, however, the building or improvement is sold
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to zhe Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(_) I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this appication is made, eacFi person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this'application , the owner, and -the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to -the work being performed under or
(� I am exempt under Sec. B.&P.C. for this reason
following issuance of this permit.
2. Any permit,issued as a result of this appication becomes null and void if work is
not commenced within 180 days from date cf issuance of such permit, or cessation of
Date: Owner:
work for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and ;tate that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for
I agree to comply with all city and county ordinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Lender's Name:
Date: Signature (Applicant or Agent):
Lender's Address:
P!
Date: 3/6/2017'
Application Number:
BELC2017-0021
Owner:
Property Address:
56259 WINGED FOOT
KIPP DOWNING
APN:
775310001,
56259 WINGED FOOT
r,7Application Description:
DOWNING / INSTALL (1) 240V 60AMP TESLA WALL CHARGER AT GARAG
LA QUINTA, CA 92253
Property Zoning:
„ Application Valuation:
$500.00
Applicant:
Contractor:
HEGGE ELECTRICAL CONTRACTORS INC
HEGGE ELECTRICAL CONTRACTORS INC -
83852 AVE 45
83852 AVE 45
INDIO, CA 92201
INDIO, CA 92201
(760)775-4855
tic. No.: 748171
Detail: INSTALL (1) 240V 60AMP DEDICATED CIRCUIT WITH HARDWIRED TESLA WALL CHARGER AT GARAGE.
2016 CALIFORNIA BUILDING CODES.
I
ACCOUNT
DESCRIPTION 77
QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION '
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$2.30
Total Paid for Credit Card Fee: $2.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, RES
101-0000-42403
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, RES PC
101-0000-42600
O
$12.67
Total Paid for ELECTRICAL: $25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00.
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
I