BELC2017-0053A
78-495 CALLE TAMPICO D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/8/2017
Application Number: BELC2017-0053 Owner:
Property Address: •79842 AVENUE 54 SILVER ROCK
APN: 777060063 79842 AVENUE 54
Application Description: SILVER ROCK/ TEMP POWER FOR CONST TRAILER LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant: Contractor:
S R BRAY LLC. DBA POWER PLUS S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET JUN ® 8 2017 1210 N. RED GUM STREET
ANAHEIM, CA 92806 ANAHEIM, CA 92806
CITY OP LA QUINTA (714)507-1881
DESIGN AND DEVELOPMENT DEPARTMENT Llc. No.: 980589
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: B, C10. D31 License No.: 980589 b
Date: Contractor: ,/� g re f d "4
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.).
( 11, 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 property who 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 Name:
Lender's Address:
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, fog the performance
of the or 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: OLD REPUBLIC GENERAL INSURANCE CORPORATION 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 Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. (ice
Date: �O Applicant:
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 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 ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: - ;--Signature (Applicant or A nt):
•
Date: 6/8/2017
Application Number: BELC2017-0053
Owner:
Property Address: 79842 AVENUE 54
SILVER ROCK
APN: .777060063
79842 AVENUE 54
Application Description: SILVER ROCK / TEMP POWER FOR CONST TRAILER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant:
Contractor:
S R BRAY LLC DBA POWER PLUS,
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET
1210 N RED GUM STREET
ANAHEIM, CA 92806
ANAHEIM, CA 92806
(714)507-1881.
Llc. No.: 980589
Detail: 100 AMP TEMPORARY POWER FOR SILVERROCK CONSTRUCTION.SITE/TRAILER. 2016
CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
TEMP POWER SERVICE _
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$17.73
Total Paid for ELECTRICAL: $43.06
DESCRIPTION
ACCOUNT
.QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00.
Bin #
CI ty Of La Quinta
Building 8L Safety Division
78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
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Owner's Name:
A. P. Number: 19 $1.�2„AVV
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Address:
Legal Description:
City, ST, Zip:
Contractor: — C_l_ P-
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Address: S 35 1 1 +1'Le M a,a ^ b' rot
Project Description:
City, ST, Zip:
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State Lic. # : Rr6D Jn i
City Lic. #;
Arch., Engr., Designer:
dbnS� . ArcAi I,e•r
Address:
City, ST, Zip:
Telephone:
State Lic. #:>::>!::::>:::«=::»;::>::>::><.:;:>.::.;>:::::s:•;>:=:::
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Construction s on T Y e: e an
Occupancy:
P cY:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: A C 9
Sq. FL:
#Stories:
#Units:
Telephone # of Contact Person: Z O SS
Estimated Value of Project: Dd 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
'TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss CRIcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans pickcd.up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review; ready for correctionsfissue
Electrical
Subcontactor. List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A: Approval
Plans resubmitted ..
Grading
IN HOUSE:-
3,d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
iFk. � 4
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