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12-1334 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00001334 Property Address: 53420 AVENIDA HERRERA APN: 774-084-010-15 -000000- Application description: ELECTRICAL Property Zoning: COVE RESIDENTIAL Application valuation: 151 Ta�/ 4 s(P Q" Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Code, and my License is in full force and effect. Lice Class: CIO Li rise No.: 850636 Date: _— b ntractor: / OWNER BULARAT ON I hereby affirm under penalty of -perjury that I am exemtractor'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 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.). 1 _ 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: R Lender's Address: Y' LQPERMIT Owner: MENDEZ CARLOS J 78665 CARNES CIR LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 ?5INSPECTIONS (760) 777-7153 Contractor: LC LIGHTING & ELECTRIC, I 74990 JONI DRIVE BLDG 3-C PALM DESERT, CA 92260 (760)862-1906 Lic. No.: 850636 Date: 11/09/12 p w u NOV i o 2012 CITY OF LA QUINTA FINANCE DEPT ------------------ WORKER'S COMPENSATION DECLARATION 1 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. K4Duel 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 FARMERS INS Policy Number C09249848 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' pensation provisions of Secti 37700 of the Labor Code, I strll forthwith comply wi hose provisions. ate: —/ App' Snt: WARNING: FAILURECURE 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, 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. I certify that I have read this application and state that the above information is correct. I agree comply with Or city and county ordinances and state laws relating to building construction, and hereby au representat s of this ounty to enter /upon the above-mentioned property pection pt%poses. 11 ate: Sig re (Applicant or Agent): Application Number . . . . . 12-00001334 Permit ELEC-MISCELLANEOUS Additional desc . . Permit Fee . . . . 15.75 Plan Check Fee 3.94 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/08/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 ---------------------------------------------------------------------------- Special Notes and Comments FIRE DAMAGE: REMOVE & REPLACE BURNT WIRING WITH NEW. INSTALL NEW DUPLEX RECEPTACLE WITH WEATHER PROOF COVER. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . ... . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 15.75 .00 .00 15.75 .Plan Check Total 3.94 .00 .00 3.94 Other Fee Total 1.00 .00 .00 1.00 Grand Total 20.69 .00 .00 20.69 LQPERAIIT Bin.# �f La Qji%I [ta Buffing 8T Safety Division P.O. Box 1504,"78-495 Calle Tampico La.Qufnta, CA 92253 - (760) 777-7012 Building Permit -Application" and Tracking Sheet Permit # i'� L Project Address: 2c)(�� I _ Owner's Name:. C L J S '-•Al CTi A. P. Number. Address: . Legal Description: City, ST, Zip:0.0 Contactor • C •� 9t, Telephone: MM Address: Project Description: fin/ "e AJ,2 City, ST, Zip: .J n,o i "7m5 j tr i ivc—,J Telephone: r� ., ? f �� ; .. y City Lia #; i w �7111J �- S LL 1.—'. Dv State Lie. # : (LC-CZ .P,j A X),J ii j2d 0,-I r4 Arch., Eagr., Designer: -� liClr� 2(. l: 1.'�i'f7f t, 1 1C�L GLe✓ Address: City, ST, Zip: -J Telephone: Y ' a State Lic. #: Name of Contact Person:Sq. Construction Type: , Occupancy: Project type (circle one): New Add'n Alter Repair Demo FL: #Stories: #Units Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan Check Deposit, Truss Ucs. Called Contact Person Pian Check Balance Tide 24 Calcs, Plans picked up Construction ' Flood plain pian Plans resubmitted ' Mechanical Grading plan 2" Review, ready for correctionsrLimue Electrical SubcOntactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review; ready for correctionsfissuc Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr ' Date of permit issue School Fees Total Permit Fees