12-0476 (ELEC)._ s
P.O. BOX 1504 4 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Dater 5/02/12
Application Number: -12-00000476 Owner:
Property Address: 46805 DUKE PALMS RD REULMAN MARK
APN: 649-020-999-A -02377 - 73088 HIGHWAY_ 111
,Application description: ELECTRICAL PALM DESERT, A
Property Zoning: REGIONAL COMMERCIAL D
Application valuation: 3500
Contractor: MAY 02 2012
Applicant: Architect or Engineer: ALPHA ELECTRI
70855 IRONWOO D VBI Y OF iA DUiNTA
RANCHO MIRAGE, CA 920MANCEDEPT.
(760)275-0578
LiC.. No..: 609042
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LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of'perjury that l am licensed under provisions.of'Chapter 9 (commencing with
Section 7000) ofDivision 3 of the Business and Professionals Code; and my License is'in full force and effect.
License Class:. C10 License,No.: 609042
Dater actor:
OWNMOUILDER DECLARATION
I hereby,affirm under penalty,of.perjury that l am exempt fiom 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 iasuance; also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provielofut of the Contractor'sState
License Lew (Chapter 9 (commencing with Section 7000) of Dhrision: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 7031:6 by
any applicant for a permit subjerts`the applicant to a civil penalty of not more than five hundred dollars (8500).:
(_) I,:aa 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 thatthe'
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 thauhs or she did not build or
Improve for the purpose of sale.).
( _') I; as, owner of the property; am,:exclusNely contracting with licensed contractors to construct the.project (Sec:
7044; Business, and Professions Code: The Contractors' State License Law does novap0y 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.AP.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 permtvis issued (Sec. 3097, CW. C.).
Lender's Name:
Lender's Address:
4QPERMTT
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 thls^permIt Is
issued.
44 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 'STATS ,FOND Policy.Number 1891779
_ I certify that, inthe, performance of the work for which this permit Wissued, (,shell not employ any
person in any manner so as to become subject to the workers' compensation lawsof California,
and agree that, if 1 should become -subject to the workers' compensation provisions of Section
3700 of the Labor Code, tall forthwith compl ith°those provisions.
Z�/Z plicant:,
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 (8100,000). IN, ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION3708 00, 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'endfeatrictionS'set'forth on %this application.
1. Each person.upon whose behalf this application is made, each personat whose request and for
whose benefit work Is performed under or pursuant to any permit.iasued 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 Quints, 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 u correct. I agree to comply with all
city and county ordinances and state laws relating to building construction,, and hereby au&horize representatives
of this c my to enter u the above merdionad property for Ins action purposes.
te:?� Z ignature (Applicant or Agent):
Application Number . . . . . 12-00000476
Permit. . . . ELEC-SERVICE
CHANGE
Additionaldesc: .
Permit Fee . . . . 52.50
P1an.Check Fee
.00
Issue Date
Valuation . . . .
0
Expiration Date 10/29/12
Qty Unit Charge Per
Extension
BASS
FEE
15.0.0
1.00 3'7.5000 EA ELEC
SVC <=60OV/>20OA/<=1000A
37.5'0
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Special Notes and Comments
--
REPLACE STOLEN MAIN BREAKER - 1000
AMP.
2010 CODES.
------------------_----------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.010
Fee summary Charged
Paid Credited
---------- ---
Due
--
----------------- ---------- ----------
Permit Fee Total. 52.50
.00 .00•
52.50
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1:00
Grand Total 53.50
.00 .00
53.50
LQPSRMIT
iron: #
• .
City Of La Quinn,
B dit,8t Safety Dlvts w
P.O Box 1504,"78-495 Cade Tampko
LR.Qufita, CA 92253 -:(760) 777=7012
BWilling Permit Application and Tracking Sheet
P+erinit d
Projeamdtess: (P
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Oamee3Name .
A. P.Number:
Addresa: .
begat tion:
City, ST, Zip:
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Pmject Description:
Address:
City. ST, Tap.. e 1 Cm C!
Telephone:
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State'Lic. 9: U
Amfi,.Bagr., Designer
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City Lik:. #:
.
,rte ��-
Address:
Ctty, ST. Zip:
Telophune:
State Lic. #:
Name of Concoct Person:
'
CarshudioaType:. Occupancy:
Projeat,type (ch de one); New Add'n Alta Repair Demo
S4 Ft :
# Stories: J # Unitx
Tdepboae # of,Coatad Person:
ft mated Value of Project:
APPLICANT: DO NOT'WRIT'E BELOW THIS LINE
p
Sobmithkl
Rea d'
. Rwd TRACMG PERbOr FM -
Plan Check sabmitted Item AmouKt
Siructatal-Cala.
Reviewed; ready for corrections Plan Check Deposit.
Truss Cale$.
Cpiled;CartaetPesos Plan Check Balance.
Tide 24 CideL
ftwe pieiked;up Qooatractlon
Floud plain plan
Plans resobntltted' . Wells"
Gilding plan
2" Review, ready for correeliossli sue Electrical
Ssbcontaetor Ust
Called ContactPerson Plombisg
Grant Deed
puns~ up $.Md.
H.O.A. Approval
Phos rc$O mkkd Grading
DV HOUSE.
, ready for eorreetlkmslissac Developer Impact Fee
Pbuming Approval-
Caw Contset perms A.I.P.P.
Pub. Wks. Appy
Date a perwit issss
Sehod Fes
Totel•Perotit Floes