BELC2014-1005Building Permit Page 1 of 1
PERMIT NO BECC2014-1005I i View;Report
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78-495 CALLE TAMPICO D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/15/2014-
Application
/15/2014Application Number: BELC2014-1005 Owner:
Property Address: 81055 GIACOMO WY IOTA GRIFFIN
APN: 767780055 4675 MACARTHUR CT NO 1550
Application Description: ELECTRICAL TEMP POWER POLE NEWPORT BEACH, CA 0
Property Zoning:
Application Valuation: $700.00
Applicant: Contractor:
S R BRAY LLC DBA POWER PLUS 5 R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET 1210 N RED GUM STREET
ANAHEIM, CA 92806 ANAHEIM, CA 92806
(714)507-1881
Llc. No.: 980589
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 License is in full force and effect.
License Class: B, C10, D31 License No.: 980589
Date:: L✓ Contractor: ��
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 any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(J 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.).
U 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.).
(-_J I am exempt under Sec. B.&P.C. for this
reason
Date: Owner:
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
perform nce of the work for which this permit is issued.
41 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.
Da
?pplicart:_0.
C
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 Building Official 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.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is
I hereby affirm under penalty of perjury that there is a construction lending agency for I correct. I agree to comply with all city and county ordinances and state laws relating
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). to building construction, and hereby authorize representatives of this city to enter
upon the above-mentioned property for inspection purposes.
Lender's Name: �
Signature (Applicant or
Lender's Address: , r t),
http://laquinta.crw.comltrakit9lDocumentViewer.aspx?&report=lDocumentsIPERMITSB... 7/15/2014
Bin #
City of La Quinta
• Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: (j 0 5 j , J—' i ,� �d wcv.
Owner's Name: L pyyLay atc-e- 5 •
A. P. Number:
Address: c) Yvton. GcTd Ixc.
Legal, Description:
City, ST, Zip: lC> YO Z
Contractor:6 U
Telephone: Ct j / ' 3 �� :,o.:;<• ..M.l:;::.::....
Address: L f7
Project Description: e �t�l0 B rcp Y d G�fiy
City, ST, Zip:1412et d::�2
6Y C'p4V2,rU G
Telephone://�� G z j ::i...::..:..•s;-H: ;;:. •:,:; ::,:•.,
V � / _ � (::v::4'.•.�:::JitJii:;%f{i:..v..i::i�j �I:�N:i:
State Lic. # : �� City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
::.<:;
...`.....:`i:
Construction Type: Occupancy:
State Lic. #:Project
type (circle one): New Add, n Alter Repair Demo
Name of Contact Person: vle'y J
Sq. Ft :
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Q - 'P c'7
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submittal
Rcq'd
Rec'd
TRACKING
PERMIT FEES,
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance_
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2,d Review, ready for corrcctionslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE--
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
DESCRIPTION
ACCOUNT QTY
PAID
PermitTRAK
$132.08
BELC2014-1005 Address: 81055`GIACOMO WY
Apn: 767780055
$132.08
BUILDING STANDARDS ADMINISTRATION BSA
$1.00
BSAS SB1473 FEE
101-0000-20306 0
$1.00
ELECTRICAL
$40.51
TEMP POWER SERVICE PC
101-0000-42403 0
$16.68
TEMP POWER SERVICE
101-0000-42403 0
$23.83
PERMIT ISSUANCE
$90.57
PERMIT ISSUANCE
TOTAL' •
101-0000-42404 0
$90.57
$132.08
Date Paid: Tuesday, July 15, 2014
Paid By: FIORENECANO HERNANDEZ
Cashier: 5KH
Pay Method: DEBIT
Printed: Tuesday, July 15, 2014 10:16 AM 1 of 1
RWCVCIFMC