12-0443 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000443
Property Address: 52700 AVENIDA HERRERA
APN: 773-294-012-12 -000000-
Application description: ELECTRICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 500
Applicant:
Ta!t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Qpde, and my License is in full force and effect.
License Class: C10 Li ns 38762
ate:tractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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).:
(_ 1 1, 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.).
(_ 1 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:
CARPINI JOSEPH & SHIRLEY
52700 AVENIDA HERRERA
LA QUINTA,,CA 92253
Contractor:
FRAZIER ELEC
PO BOX 96
LA QUINTA, CA 92247
(760)772-5830
Lic. No.: 938762
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/23/12
ANN R
D a a
APR 2 3 ;2012
CITY OF LA (2UINTA
FINANCE DEPT.
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 EXEMPT Policy Number EXEMPT
tv ' 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 tote wortcompensation provisions of Section
X73700 of the La r Cod II forthwi i ose provisions.
licant:
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 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, indemnity 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building c truction, and he by aut representatives
of thi -county to enter upon the above-mentioned prope r inspection p
RIZ
ate: Z� 'nature (Applicant or Agent):
Application Number . . . . . 12-00000443
Permit
ELEC-SERVICE CHANGE
Additional desc .
Permit Fee . . .
. 33.50 Plan Check Fee
.00
Issue Date
Valuation . . .
0
Expiration Date
10/20/12
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
1.00 18.5000
EA ELEC SVC <=600V/<=200A
18.50
----------------------------------7-----------------------------------------
Special Notes and
Comments
REPLACE DEFECTIVE
200 AMP ELECTRIC METER
WITH NEW 200 AMP
ELECTRIC METER. 2010
CODES.
----------------------------------------------------------------------------
Other Fees
. . . . . BLDG STDS ADMIN (SB1473)
1.00 _
Fee summary
-- - - - - - - - - - - - - ---
Charged Paid Credited
---- - - - - ------ - - - - ------ - - - - ----
Due
-- - - - - - -
Permit Fee Total
33.50 .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
34.50
LQPERMIT
Bill #
0 QWho
Buliding 8L Safety Division -
P.O. Box 1504,79-495 Calle Tampico
(a.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:.
A P. Number.Address: I'5;z..;-7vc)
.��• C��
Legal Description:
Contractor. ���� •
City, ST, Zip:
Telephone::
Address: V T14
Pmject Description:
City, ST, Zip: 3
-- -'
Telephane:'7Cd—
�'��„ <;y"'r-
20 O C. � #" •� `L.
State Lie. #: (e� City Lie.. #; Q n
Arch., Engr., Designer
(�
Q_��• .
Address:
�.. .
City., ST, Zip:
Telephone:
State Lie. #:
Construction Type:. i R Occupancy: *7
Project type (circle one): New Add'n Alter epair Demo
Name of Contact Person:
Sq. Ft: x`•100• # Stories
#Units: Q
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE.
#
Submittal
Rcq'd
Recd
TRACKING PERMIT FEES
Pian Sets
Plan Check submitted item Amount
Structural Cafes.
Reviewed, ready for corrections Plan Check Deposit •
Truss Cales.
Called Contact Person Plan Check Balance
Title 24 Cabs.
Plans picked up Construction
Flood plain plan
Plans resubmitted .' . Mechanical
Grading plan
2'' Review, ready for correctionslissue Electrical
Subcoatactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SALL
H.O.A. Approval
Plans resubmitted Grading
IN HOME-,
'"' Review, ready for correetionAssue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P'.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees