BELC2017-002478-495 CALLE TAMPICO D �awNUCl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0024
Property Address: 53610 AVENIDA VILLA
APN: 774134006
Application Description: KRAUSE RESIDENCE / 200 AMP MAIN PANEL REPLACEMENT
Property Zoning:
Application Valuation: $5,420.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777=7153
O Nner:
RICHARD KRAUSE
5=•610 AVENIDA VILLA
LL. QUINTA, CA 92253
Applicant: Contractor!
DESERT ELECTRIC DESERT ELECTRIC
55888 YUCCA TRAIL 6 55888 YUCCA TRAIL 6
YUCCA VALLEY, CA 92284 YUCCA VALLEY, CA 92284
(750)369-1002
Llr. No.: 879507
Date: 3/28/2017
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I I hereby affirm under penalty of perjury one of the following declarations
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3760 of the Labor Code, for the performance
License Class: C10 License No.: 879507
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Date: Contractor:.
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: SENTINEL INSURANCE COMPANY LTD Polity Number: OIWECGC5232
1 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 iu any manner so -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 provigons 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,
( ) I, 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 ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES A'S 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.
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
APIMICANT ACKNOWLEDGEMENT ,
. within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a Permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restriction! set forth on this application.
(_) I, as owner, of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each 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 omisaion related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
following issuance of this perrait.
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
Date: Owner:'
work for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state 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):•,
a
_
Date: 3/28/2017
Application Number:
BELC2017-0024
Owner:
Property Address:
53610 AVENIDA VILLA
RCCHARD KRAUSE
APN:
774134006
53610 AVENIDA VILLA
Application Description:
KRAUSE RESIDENCE / 200 AMP MAIN PANEL REPLACEMENT
LF. QUINTA, CA 92253
Property Zoning:
Application Valuation:
$5,420.00
Applicant:
Contractor:
DESERT ELECTRIC
DESERT ELECTRIC
55888 YUCCA TRAIL 6
55888 YUCCA TRAIL 6
YUCCA VALLEY, CA 92284
YUCCA VALLEY, CA 92284:'
l
(750)369-1002
Llc. No.: 879507
Detail:
v.
,o
DESCRIPTION ACCOUNT QTY AMOUNT
I
ACCOUNT
BSAS SB1473 FEE 101-0000-20306
0
$1.00
502-0000-43611
0
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-4350;
' 0
$2.75
Total Paid for Credit Card Fee: $2.75
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICE CHANGEOUT/UPGRADE
101-0000-4240-
0
$25.33
`
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICE CHANGEOUT/UPGRADE PC
101-0000-4260C
.0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
t Total Paid fon PERMIT ISSUANCE: E $96.27
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00