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BELC2016-003278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-i&t 4 4 Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BELC2016-0032 Property Address: 53260 AVENIDA RAMIREZ APN: 774082001 Application Description: WARDEN / REPLACE MAIN BREAKER Property Zoning: Application Valuation: $250.00 Applicant: DON HEGGE ELECTRIC 43652 PALERMO COURT LA QUINTA, CA 92253 LICENSED CONTRACTOR'S DECLARATION 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 Professions Code, and my License is in full force and effect. License Class: C10 License No.: 49 49 Date: ---) "')C_) ^ 1 Ai Contractor OWNER -BUILDER DECLARATION I hereby affirm 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 ($500).: (_) 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. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of propertywho builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.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 Lender's Address: 11111111111111111111 46 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/30/2016 Owner: DAVID WARDEN 2243 LINCOLN RD VICTORIA BC CANADA V8R, A3 92253 Contractor: DON HEGGE ELECTRIC 43652 PALERMO COURT LA QUINTA, CA 92253 (760)200-5981 Llc. No.: 491949 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� which this permit is issued. I ve 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:- Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall 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 Se ion 0 of the lab Co , I shall forthwith comply with those provisions. Dat V Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS LVLAWFUL, AND SHALL SUBJECT AN EMPLOYERTO 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 Building Official 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 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, 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. 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 correct. I agree to comply with all city and county ordinarof tate laws relating to building construction, and hereby authorize representativis ci o enter upo the above-mentioned property for inspection purpos I Date: :DZ;() 1 (176)signature (Applicant or Agent1_A �� FINANCIAL 1 • DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE OTHER ELECTRICAL EQUIPMENT 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE OTHER ELECTRICAL EQUIPMENT PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $48.34 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE:. $91.85 $0.00 TOTALS:00 Description: WARDEN / REPLACE MAIN BREAKER CONDITIONS Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 3/30/2016 SKH Approved: Parcel No: 774082001 Site Address: 53260 AVENIDA RAMIREZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 224 Lot: 24 Issued: UNIT 21 NAME TYPE NAME Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $250.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites:.0 DON HEGGE ELECTRIC Details: ELECTRICAL- CHANGE OUT MAIN BREAKER. 2013 CALIFORNIA BUILDING CODES. e ADDITIONAL SITES CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT DON HEGGE ELECTRIC 43652 PALERMO COURT LA QUINTA CA 92253 CONTRACTOR DON HEGGE ELECTRIC 43652 PALERMO COURT LA QUINTA CA 92253 OWNER DAVID WARDEN 2243 LINCOLN RD VICTORIA BC CANADA V8R A3 92253 Printed: Wednesday, March 30, 2016 9:55:48 AM 1 of 2 SYSTEMS Printed: Wednesday, March 30, 2016 9:55:48 AM 2 of 2 097srsrEMs CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: OTHER ELECTRICAL 101-0000-42403 0 $24.17 $0.00 EQUIPMENT OTHER ELECTRICAL 101-0000-42600 0 $24.17 $0.00 EQUIPMENT PC Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 To I $91.85 I $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:• •• Printed: Wednesday, March 30, 2016 9:55:48 AM 2 of 2 097srsrEMs Bin # City of La Quinta Building 81: Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ��l[p Project Address: Z,�o �Z Owner's Name: A. P. Number: Address: 5 P-rwlAteL✓z— Legal Description: City, ST, Zip: ciav 7 - Contractor: Contractor: G e C.. Telephone: Address: wC Project Description:, City, ST, Zip: C� Telephone: 6 State Lic. # : City tic. #t Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Construction Type: Occupancy: State Lu. #: Project t hP (circle one • New w Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: CU Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE M Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2n1 Review, ready for correclionsfissue Electrical Subconlactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.T. I-I.O.A. Approval Plans resubmitted Grading IN IfOUSE:- ''J Review, ready for correctionstissuc Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees