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13-1280 (ELEC). <:il�4 P.O. BOX 1504 VOICE (760) 777-7012 1 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT SPECTIONS'(760) 777-7153 BUILDING PERMIT�� Q ate: 10/08/13, Application Number:- 13-00001280 Owner: G��LII Property Address: 80045 VISTA GRANDE' HELEN KOZLAK APN: 649-1427002-17 -3505 80045 VISTA GRANDE ®e/ Application description: ELECTRICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ( �� ow Application valuation: 1000 Contractor: Nc�O��r/9 Applicant: Architect or Engineer: MASTER REPAIR ELECTRIC 85564 STACIE.LANE- COACHELLA, CA 92236 . (760-)601-6324 • Lic. No.: 779861 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION ` I 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 Professionals 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 , License Class: • C10 License No.: 779861. for by Section 3700 of the Labor Code, for the performanceof the work for which this permit is Daterp/ issued. —p'�Zi Contractor%QSJYjy - - - _ 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 perjury that I am exempt from the Contractor's State License Law for the - Carrier MPT Policy Number EXEMPT 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 which 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 so as to become subject:to the workers' compensation laws of California, 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 should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000)Iryof Division 3 of the Business and Professions Code) or 37o0 of the Labor CI shall forthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a • _ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: - Dater Applicant:- (_) 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 WORKERS' 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work 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 (_) 1, 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 coritractor(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 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. Date: Owner: 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 CONSTRUCTION LENDING AGENCY - permit to cancellation. - - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct..I agree to comply with -all work for which this permit isissued(Sec: 3097, Civ. C.). - - - city and county ordinances and state laws relating to buildi construction, and hereby authorize representatives of this county to enter upon the above-mentioned grope r inspection purposes. Lender's Name: - - ' Date/�y� �� Signature (Applicant or A _ Lender's Address: LQPERMIT _ I Application Number 13-00001280 Permit ELECTRICAL 2013 Additional desc. Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . 0 Expiration Date 4/06/14 _ Qty Unit Charge Per Extension 1..00• 23.8300 EA ELEC SERVICES 23.83 Special Notes and.Comments ELECTRICAL - REPLACE MAIN PANEL 200 AMP. 2010 CALIFORNIA BUILDING CODES. ------------------------------------------------------------------- Other Fees . . . . PLAN CHECK, ELECTRICAL 11.92 PERMIT ISSUANCE M/P/E 90.57 ' Fee summary Charged Paid Credited Due Permit Fee Total 23.8 - - - - - - 3 .00 .00, ----'23.83 Plan Check Total .00 .00 .00 ,00, Other Fee Total' 102.49 00 .00 102.49' Grand Total 126.32 .00 - 00 126.32 LQPERMIT R Bin # -City of La Quinta . Building &r Safety Vvision P.O: Box 1504, 78-495 Calle Tampico La Quinta, CA 92253. (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: - 1 wesName A. P. Number: :Address: S Legal Description: i . Contractor: a City, ST, • 2Z�3 Telepho Address: Project scription: City, ST, Zip: • Teleph • ak< P e 74 .._ State City Lie. #; R Arch., Engr., Designer: Address: City., ST, Zip: Telephone:•: P tn::.v}:yi;:r i^iii; •}}'l.: nom:::. "'`:;..:;.;>:..:•::•....}y:.}y.•}:y::..y:.:,x >.......... . 5:• �:}yfry:�::i:•r:::%2^.':Uo�:;�hi:�r,.:..,:.:.;: <•.:,r<:•,:<.•<.:•• : n•.:.} :<» <:g. Constru t' cion Type: Occupancy: State Lic. # Project type (circle one): New Add, n Alter Repair Demo Name of Contact Person: �� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ' Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections. Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Pians resubmitted Grading IN HOUSE:- '"` Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person, A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees