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12-1234 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:12�000.1234 Property Address: 79625 VISTA CORALINA APN: 600 -020 -054 - Application description: ELECTRICAL Property Zoning: COMMERCIAL PARK Application valuation: 50000 T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: LN LA QUINTA HOUSING AUTHORITY - 78495 CALLE TAMPICO LA QUINTA, CA 92253 VOICE (766)1: FAX (760) T/7- INSPECTIONS (760) 777-7153 Date: 10/16/12 Contractor: Applicant: Architect or Engineer`NATIONAL CONSTR RENTINIQ 15319 CHATSWORTH STR MISSION HILLS,,CA 91 a (818)221-6057 IV PI Lic. No.. 687160 ------------------------------ ~ LICENSED CONTRACTOR'S DECLARATION I I WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Profes ' als Code, and my License is in. full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided . 1i se Clas�CJD3,. License No.: 687160 - ,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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of p jury that I am exempt from the Contractor's State License taw for the Carrier TRAVELERS 'PROP Policy Number TC2JUB4246B88A1 following reason (Sec. 7031 .5; Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for wh!pq this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so5elpl% o e workers' compensation laws of California, t permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I shouworkers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or t 3700 of the Labor Codey with those provisions. that he or she is exempt therefrom and. the basis for the alleged exemption. Any violation of Section 7031.5 by �4L­ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: - Date:cant: (_ 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 WARNING: FAILURE TO SECURE V,IA KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CROeNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who doesthework himself or herself through his or her own employees, provided that the DOLLARS ($100,000)" IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within - SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' 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.). APPLICANT ACKNOWLEDGEMENT (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - - property who builds or improves thereon, and who contracts for the projects with a. contractor(s) licensed . 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City f L O iff' nt and m I es for an act or omission related to the work being 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: o a unta, its o kers, age s e p oye y 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�ereby I agree to comply with all city and county ordinances and state laws relating to building construction,uthorize representatives of this county to enter upon the above-mentioned property for inspe tl� . urposes: 61ate:S' nature (Applicant or Agent): LQPERMIT - - -J' �' --�— Application Number . . . . . 12-00001234 Permit . . . ELEC-TEMPORARY POWER Additional desc . Permit Fee 135.00 Plan Check Fee .00 Issue Date . . . Valuation 0 Expiration Date 4/14/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 14.00 7.5000 EA ELEC TEMP SUB POLE 105.00 Special Notes and Comments TEMP POWER: 600 AMP _CABINET, 14 SUB . POLES & 40 BARE POLES. 2010 CODES -------------------_--------------------------------------------------- Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 135.00 00 .00 135.00 Plan Check Total .00 .00 .00 .00 - :; Other Fee Total 1.00 .00 00 1.00. Grand Total 136.00 .00 .00 136.00 -'LQPERMtT` ' Bin.# City. of La Quinta Building &I Safety Division Permit # P.O. Box 1504,'78-495 Calle Tampico ,1 12' ta.Quinta, CA 92253 -{760) 777-7012 Permit' Building Application and Tracking Sheet Project Address: (o. ` ( Owner's Name:. - A P. Number. 0(s --0 a _ S` Address: .11 L. `i Let ? Description: al i gC�((o 2 To �. s City. ST, Zip: Z Lp { Contractor: • -� r— i t� Telephone: / /c��";a:'x�.'r'•'<.Altifr�:.s:Kys Address: 53 n w0 h Project Description: City, ST, Zip' Telephone. r� / A f��C� I' '©JSCN j State Lic. # : City Lic. Arch., Engr., Designer S v j Address: City., ST, Zip: Telephone: �. Construction Type: eSt Occupancy: i State Lic. #:. Project type (circle one): ew Add'n Alter Repair Demo I Name of Contact Person: g Sq. L #Stories: #Units Telephone # of Contact Person: Estimated Value of Project C) 00 e APPLICANT: DO NOT WRITE BELOW THIS UNE !/ SubmIttal Req'd Recd TRACMG PERMIT FEES- EESPlan PlanSets Plan Check submitted Item Amount s .Structural Caicc. Reviewed, ready for corrections - Plan Check Deposit. Tress Calcs. Called Contact Person Plan Check Balance. Tide 24 Cans. Plans picked up Construction' _ Flood plain plan - _ -Flails-�esubniitted -- '—�— -Mechanical Grading plan 2•f Review, ready for corrections/issue Electrical Subeoatector List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O A Approval Plans resubmitted Grading IN HOUSE:- 1n° Review{ ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Ad.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees