09-0869 (ELEC)P.O. BOX 1504
78=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0;9-00000869
Property Address:
782.11 HACIENDA LA QUINTA
APN:
646-280-016- — -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY ,RESIDENTIAL
Application valuation:
290,0
Applicant: Architect or E ineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby -affirm under penalty of perjury'that"I amdicensed 'under provisions of Chapter 9'(cornmencing;with
Section 7000) of'Divisiom3 of the Business and Professionals Code; and my License is in full fome.an_dleffect.
L'icense'Class: C10 Liosnse No.: 708886
OatesContractor:
O WNER.BUILDER,DECLARATION
I hereby affirm under penalty of perjury.that:l arr 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 6 permit to
construct, alter„!improve, demolish, or repair any structure, prior to.its,issuance, alsorequires:the applicant for the
permit to file a, signed statement that he;orshe,is licensed pursuant4o;the provisions of the' Contractor's State
License,Law (Chapter.9; (commencing with Section.7000)'of `Division3fof the Business .and PnrofessioCode) or
that -he or she is exempt therefrom and the basis for'thealleged exemption. Any violation of Section 7031.5 by
any applicant fora permit.subjects the applicant to a civil penalty ofmot morethan five.hundmd' dollars (9500)::
1—) I, as owner of the property; or my employees with, wages. as their sole compensation, will do the work, and
the structure isnot 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 theworkhimself'. or herself through his or her own employees, provided that the
improvements are,not intended or offered for sale. If, however,.the building or improvemenvis sold within
oria year of completion, the owner -builder will have the burden of proving that he or;she'di& not:build or
improve for the purpose ofsale.):
1 _ 1 1, .as owner of'the property;: am exclusivelycontracting,with.licensed contractors to construct the project (Sec.
7044, Business and Professions,Code: The Contractors' State License Law doesnot applyto an owner of
property who builds or improves thereon,:and who contrectsfor the projects with,a contractor(s) licensed.
pursuant to the Contractors' State License Law.);
(_ 1 I amexemptunder Sec. , B.&P:C. forIthis reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is 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:
L.QPERMTP
VOICE (760) 777=7012
.FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/113/09
Owner:
CREWS JACKIE
78211 HACIENDA LA QUINTA
LA QUINTA, CA.92253
A
Contractor'.
SOUTHERN COMMUNITY
74355 OLD.PROSPEC�
PALM DESERT, CA 9
(760)674.=3160
Lie. No_: 708886
�3 2009
-------------------
WORKER'S COMPENSATION DECLARATION
I'hereby affirm,underpenalty of perjury,one of the.following declarations:
1: have and will. maintain a'oertificate 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 'th_ is�permifis issued. My workers' compensation
insurance carrievand policy number are:
Carrier EXEMPT Policy Number EXEMPT
1 certifythat, in the performance of the work for Which -this permit ie.issued; I shallnoteniployany
persomin any manner so as to become subjecbto 4he workers' compensation laws of California,
and agree that:if;lrshould become subject to the,workers' compensatiomprovisions of Section
3700 of the.Labor Code, I,shall forthwitn;comply with those provisions.
Date: 13-0
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'($160,000).. 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 sei forth omthis application.
1. Each personn-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 a_sa result of this application,.
the owner, and the applicant, each .agmesao;<and'shall defend,. jndemnifyand4hold harmless,the City
of La Quinta, its.officers, agents and employees for any acuoromission related to the work being
'performed under or following issuanceof -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.cancelletion..
I certify that I have read this application and'state:that the above information.is,correct. '1 -agree to comply with all
cityand county ordinances and state laws relating to building construction,•and heiebyauthorize.representatives
of;this'county to enterupomthe above-mentioned property for inspection purposes.
Date: '5-13-agSignature (Applicant or Agenq `�_
Application Number . . . . . 09-00000869
Permit . . . ELEC-SERVICE CHANGE'
Additional desc
Permit Fee . . . . 33.50
Plan Check Fee
.00
Issue Date . . . .
Valuation . .
0
'Expi-ration,Date 2/09%10
Qty Unit Charge Per
Extension
BASE.FEE
15.00
1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
--------------- -------------------------------_-------
Special Notes and Comments
--------
-----------
REPLACE EXISTING 2.00 AMP SERVICE:WITH
A
NEW 20.0 'AMP SERVICE.
---------------------------------------------------.------------
Other• Fees . . . . . . BLDG STDS ADMIN (SB1.473)
---------
1.00
Fee summary Charged
Paid Credited
Due
- -------------------
Permit Fee Total 33.5.0
-----------:----------------•---
.00 00
33.50
-Plan Check Total 00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 34,.50
.00 .00
3.4.50
LQPERMff
City of La Qainta
Building 8t'Safety Division
Permit #
P.O. Box 1`504, 78-495 Calle Tampko
`
La QLdnta, CA 92253 - (760) 777=7012
Building Permit Application and Tracking Sheet
'Owiier's�Name
A. R. Number: Address:
Legal Description:
_ City, STZip:
�'ORtraCiOC ` r
Telcpbo .
Address: d t D - - - -s
.�5✓S Projoctvikription:
City, ST, Zip: — 902
Telephone: 760 _ 6'7 —3 GCU
State Lic.: # : 7pFSggi
Arch., Engr., Designer
Address:
City, ST, Zip:.
e ep one: Construction Type: Occupancy:
State Lic. #:
Project type'(circle.one): New Add'n Alter Repair Demo
Name of Contaci.Person: jy V Sq. it Stories: #,.-Units:
Telephone # of Contact a: Estimated Val3e of, ecx "-Z%. Oct
^.
APPLICANT: DO. NOT`WRITE BELOW THIS UNE
#
Submittal'.
Req'd
Recd
TRALXMG PERMIT FEES
Plan,Sets
. Plao Check submitted
Item Amount.
Structural Coles,
Reviewed; ready for corrections
Plan Check Deposit
Truss Calcs..
Called Contact Person
Plan•Cheek-Balance'..
Tlde 24 Cales.
Pians pick d up
Construction
Flood. plain plan
Plans resubmitted
Mechaadea)
Grading plan.
2" ,Review, ready for correetiouslinue
ElecMcal .
Subcontector list.Ca11ed.Contact
Person
Plumbing
Grant Deed
Plana picked up.
S.M.I.
H:OA. Approval
Plans resubmitted
Grading
1N HOUSE:-
Review, ready for correctiooslinue
Developer, Imp_ aet Fee
Planning Approval
Called Contact Person_
A.LP.P.
Pub. Wks. Appr
Date ofpermit issue
School -Fees
Total Permit Fees
GAF—\A-16 , $ - 13 —09
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Electric 'Serviost Inc
74366 Old ProopwWr Trail
Pe1m Desert, CA 99260
(760) 674-3160
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