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12-0263 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application. Number: 12-00000263 Property Address: 51225 EISENHOWER DR UNIT A APN: 773-06.5-021-10 -00.0000- Application description: ELECTRICAL Property Zoning: VILLAGE COMMERCIAL Application valuation: 800 Annlirrant- Architect or Engineer: p(a ------------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that ) am licensed under provisions of Chapter:9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code,. and my License isin full force and effect. License Class: C10 License No.:, 944894 ate.-�-Z�-/� ntractor• � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury thea l 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,applicarn for the permit to•file a signed statement thathe 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,-as 9500).:I,.as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not.imended 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 (s.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, as owner'of the property, am exclusively contracting'wtth 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 tor the Contractors' State;License Law.). (_) I am exempt under Sec., , B.&P:C. forthis reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 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: I:QPERMIT Owner: - MOONEY GEORGE R 75205 STARDUST IN INDIAN WELLS, CA 92210 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/21/12 . a ° Contractor: �A MOX ELECTRIC LIAR 21. 2112 54225 AVENIDA:MENDOZA LA QUINTA, CA 92253 (760),567-3,,661 CITY OFW(QUIWA Lic. No. 944894 FKA-1-4CEOEPT WORKER'S COMPENSATION DECLARATION I hereby, affirm under penalty of perjury one of the following declarations: _ I have and Will;mainton a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for thaperformancerof the work for which this permit is issued. _ 1 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 I,certify,that, in the performance of the work for which this permit is issued, Lshali 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 all forthwith comply with those provisions. Appll� WARNING: FAILUR OE'T 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 SECTION 3708 OF THE LABOR CODE, INTEREST,,AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application; is hereby madeto the Director of Building and Safety fora 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 Quima, its officers, agents.and�employees for any act or omission related to the work being performed under or following issuanee:of this permit. 2. Any permit Issued:as a.result .of thisapplication becomes.null,and void if work isnot commenced within 180 days from, date of issuance of such permit, or'cessation of'work 'for ISO 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 construction, and hereby authorize representatives of this county to anter u the above-mentioned prope/rtylspection a. Date — Signature (Applicant or Agent): Application Number 12-00000263 Permit— . . . ELEC-SERVICE CHANGE Additional desc . Permit Fee . . . . 33.50- Plan Check Fee .00 Issue Date . . Valuation . . . . 0 Expiration Date . . 9/17/12 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 200 AMP MAIN PANEL LIKE FOR LIKE. 2010 CODES. ----------------------------------------- ---------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.0,0 Fee summary Charged Paid - Credited Due ----------------- ---------- ------- - -- ---------- ---------- Permit Fee Total 33.50 .0.0 .00 33.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .0.0 .00 1.00 Grand Total .34.50 .00 .00 34..50 LQMRMrr 1 City . La QuInBimf ta Bulkfig m Safety DhWw . ... . P.O. Box. 1504,' 78495 Calle Tampico- La Qtdnta, CA 92253 • (760) 777=7012 Buliding Permit Application- and Tracking Sheet jeaAddtess:.S'�.ZZSr €' cvna'sNeare:. CIi i/.� rA- P:Number j� .,d nil_ lQddress: ,S� Z2 Segal Description: a ity, ST. vp: L / G Ili i� Cal Z2 S� 3 Contractor c i C elephone: J'A Address: Z2 It 1i'rC'v rojectDescription: ' ' City, ST,Zip4 Vi e -C i Z45-5©OA ^4610V Ae( a a Telephone: 26p' (-,6 coo r� a; q aF% State Iiia #: City Lia C. 2,.r Al Alit • AMM= City, ST. Zip:. Teleplioae: C.onstraction Type: Rios• ompan y: SPS State Iiia #: Project type (cirde one): 'New Add'n Alta Demo Name of.conw Person: Sq.,Et.: # Stories: ' # Univ: Telephone # of Contact Person: fistuaatod VaWe of Project APPLICANT: DO NOT WRITE BELOW THIS LINE # S"Ittal Wd Reed TRAGIC PERMIT FEES Plan Sets Plaa.Cbecttaabmitted hear Amoaat aractaral Cala. Reviewed, ready for eor""dons Plan Check Deposit. . Trw Cal" Catletcaataet Pasoa Plan Cbe* Balanct. 19de ?A Cala. Plans plebod up Coastraed4a Flood plata plan Plana resalaniftd • . MecUnkal Giadiog plan 2'! Review, ready for oorreedournsae Electrical Sabeontaetor list Carted Coalaet Person Plumbing GreatMed Phot pidoed up ML H.O.A. Approval Plaas,resabmiftil Grading IN HOUSM- ''' Review; ready for tormdonsAme Developer Impact Fee fUn dag Approval Called Coataet Person A".P. Pub. Wks. Appy Date of permit bsae' &Md Fen Total Permit Few