12-0449 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000449
Property Address:
80092 VIA TESORO
APN:
772-250-018-3 -31349
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
T44t 4 4 Qm&&
Applicant: Architect or Engineer:
VP
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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.
License Class: B License No..677877
Date�?__ Contractor: '�{(♦^�/L l�'i/P S /�-FSC�%�r/
OWNER -BUILDER DECLARATION'
I hereby atfirm under penalty of perjury that I 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 (5500).:
(_ I 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7nnn, Riisinf69A and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves iher66?1, anu wnu wniwvto far tho prnjarts with a rgntrpgtor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.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:
WILLIAM BAIN 80092 VIA TESORO IFD
LA QUINTA, CA 92253
Contractor:
DAVIS RESTORATION OF
77833 PALAPAS ROAD
PALM DESERT, CA 92211
(760)360-1855
Lic. No.: 677877
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/12
w u
APR 25 2012
I;VF LA QUINTA
ANCE 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 NATIONAL UNION Policy Number 910606
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
persuit in any monner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensailoii provisions of Section
/ 3700 of the Labor Code, I shall forthwith comply with those provisions.
�7
Date: `ZS /Z Applicant: R 4— /,) /qv; S /C'�i.. %p�/��i( ,Aj
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
v.-hnrn honefit work 15 00rformed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agreeS 10, anu shall indomr+ify 2nd hold harmloSs 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 c e . omply with all
city and county ordinances and state laws relating to building c truction, a hereby uth ize r resentatives
of this county to enter upon the above-mentioned propert specti r S.
Date: 7 / ignature (Applicant or Agent):
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
12-00000449
ELEC-TEMPORARY POWER
30.00 Plan Check Fee . . .00
Valuation . . . . 0
10/21/12
Qty Unit Charge. Per Extension
BASE FEE 15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
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Special Notes and Comments
TEMPORARY POWER POLE FOR DEMOLITION OF
ROOF/CEILING ASSEMBLY AND FUTURE REMODEL
OF FIRE DAMAGED RESIDENCE.
April 24, 2012 3:43:23 PM AORTEGA-
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged
Permit Fee Total 30.00
Plan Check Total .00
Other Fee Total 1.00
Grand Total 31.00
LQPERMIT
Paid Credited Due
.00 .00 30.00
.00 .00 .00
.00 .00 1.00
.00 .00 31.00
\
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BLdWZRg a Safety Division
P.O. Box 1504, •78-49S Caffe Tampico
1.a.Writa, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheec
Permit #
Project Addeess:j
Z Jl
Owner's Name:.
A P. Number.
Addr= C)C)Z
Legal Description:
City, ST, Zip: f:.lQ- (yI k-� e4 22
ContractorL
t
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Telephone:
y�
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Address: ^T'7g3 3.
Project Description: pCrrk
City, ST,
Telephone:
State Lia # :
Arch, Engr., Designer
_ Lrfl
City Lie 9, $ �" b
_ %l
Address:
�ljfL I "IJ o .) L16- lZ-fg
City., ST, Zip:
Telephone:•Construction
Name of Contact Person
Type: f 7OccuPmr-y:S I IJStateLiag:Project jDemno.
type (circle one): New Add'a Filter Repair
Sq. Ft : 3 �D #Stories:
p Tin -its:
Tdephonc # of Contact Person:
Estimated Value of ProjectO ?j� C3�-►
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Rcq'd
Recd
TRACMG P311MIT FEES
Plan Sets
Plan puck submitted
Amount
Structural Coles.
Reviewed, ready for corrections
Plan puck Del^osit. ,.
Truss Cala.
Called Contact Person
Pian Check Babnce
Tide 24 (ales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'! Review, ready for corrections/asue
Electrical
Sobcontaetor List
Called Contact Person
Plumbing
Groat Deed
Plans picked up
&WL
ILOA. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review; ready for eoriectionvissue
Developer Iuspaet Pee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr "
Date of permit issue
School Fees
Total Perm& Fees