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BELC2017-0032rA. 78-495 CALLE TAMPICO C� 0 D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BELC2017-0032 Property Address: 78271 HIGHWAY 111 APN: 604050061 Application Description: SAFEWAY / VONS / ADD NEW SUBPANNEL AND 6 NEW OUTLETS Property Zoning: Application Valuation: $45,000.00 Applicant: DWAIN DELOACH ELECTRIC 14287 CALLE DE VISTA APR 2 0 2017 VALLEY CENTER, CA 92082 DD CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT 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*DECLARATION essions Code, and my License is in full force and effect. License Class: QC10-7� License No.: 100897 Date:. %''� / -Gyl 7 ContR r OWNER-BUI 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.). (1 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 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 Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/20/2017 Owner: SAFEWAY INC 5918 STONERIDGE MALL RD PLESANTON, CA 94588 Contractor: DWAIN DELOACH ELECTRIC 14287 CALLE DE VISTA VALLEY CENTER, CA 92082 (760)822-6052 Llc. No.: 1008979 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: SENTINEL INSURANCE COMPANY LTD Policy Number: 72WECGI1225 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 tbe Labpr Code, I shall forthwith comply with those provisions. D et : Lf—/r —1?Ap t: 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 DOL LARS-($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 u on the above- mentioned property for inspection purposes. D'afe-:1��/Signature (Applicant or, ,Agent) Owner: SAFEWAY INC 5918 STONERIDGE MALL RD PLESANTON, CA 94588 Date: 4/20/2017 Applicant: Contractor: DWAIN DELOACH ELECTRIC DWAIN DELOACH ELECTRIC t 14287 CALLE DE VISTA Application Number: BELC2017-0032 Property Address: 78271 HIGHWAY 111 APN: 604050061 Application Description: SAFEWAY / VONS / ADD NEW SUBPANNEL AND 6 NEW OUTLETS Property Zoning: CODES. Application Valuation: $45,000.00 Owner: SAFEWAY INC 5918 STONERIDGE MALL RD PLESANTON, CA 94588 Date: 4/20/2017 Applicant: Contractor: DWAIN DELOACH ELECTRIC DWAIN DELOACH ELECTRIC 14287 CALLE DE VISTA 14287 CALLE DE VISTA VALLEY CENTER, CA 92082 VALLEY CENTER, CA 92082 (760)822-6052 -------------------------------------------------------------------------------------------- Llc. No.: 1008979 Detail: INSTALL NEW 225A SUBPANEL WITH FOUR (4) 30A CIRCUITS FEEDING EXTERIOR RECEPTACLES FOR REFRIGERATION TRUCKS AND TWO (2) 20A CIRCUITS FEEDING RECEPTACLES AT PPD/DESK. NEW SUBPANEL FED THROUGH EXISTING 125A OCPD AT EXISTING SERVICE. 2016 CALIFORNIA BUILDING CODES. d DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $2.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 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 t t Bin. # • • • Clltj/ Of Lc1 Quints Building 8t Safety Division Permit # P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 :.i 8EL a ©► 3 a Building Permit Application and Tracking Sheet ProjectAddress: 78-271 CA -111. Owner's Name:. Safeway Inc A- P. Number. Address: 5918 Stoneridge Mall .Rd Legal Description: City, ST, Zip: Plesanton Ca 94588 Contractor. DeLoach Electric Telephone:925-998-3990 Aad:14287 Deripton: Calleasa x 1 sub- anel 125 am city, sr, zip: Valley Center Ca 92082 6 circuits D 3 !1 Telephone: 760-822-6052;-reuc,< vtl S - State Lic. #: City Lic #: U isu Designer p ` 1 i Address: c,ty, ST, Zap.DFS 1G oP A i 8,4 L { j Telephone: State Lic. #: Name of Contact Person: Carl Hoff Construction Type: oc�upY= retail' Store Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories: #Unite: j Telephone # of Contact Person: — 3-3474 Escimalcd value of Project $ 4500,00 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING PERMPI' FEES - j Pian Sets Plan Check submitted. Item Amount StrgctumI Caies. Reviewed, ready for corrections Plan Check Deposit, . Truss Coles. Called Contact Person Plan Check Balance_ Tide 24 Coles. Plana picked up Construction Flood plain plan Plans resubmitted.'. Mecharitcal Grading plan 2" Review, readyfor correctionsfiasre Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up Shu H.O A Approval Plans resubmitted Grading IN HOUSE:- Dn° Revlew, ready for Corr"eveloper Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr - Date of permit issue School Fees DELOAC. H ;;;E LECTRI 1:4287 Calle: De Vista Valley Center :CA 92082 (760) 822=.6052 License #1008979 April, 2017 To' whom it may concern, Vons -La Quinta Electrical run use existing (abandon) 125 amp main switch gear breaker install 1 1/2" emt conduit to 225amp rated main lug panel approx. 1601f install 3 x #1 copper THHN conductors, 1 x #1 copper THHN common, 2 x #8 copper THHN grounds install 1 dirty ground bar for L15030 receptacles, 1isolated ground bar for ppd-desk install 3/4" emt, #10 THHN copper x 6 conductors , #10 THHN x 2 grounds per emt run, longest run approx 140 LF install 2 conduits runs for'4 dedicated circuits install 4 x 30amp L15-30 receptacles, install 4 extra duty cover, install 4 weather tight bell boxes. install 2 x 20amp single circuits to desk and PPD from main lug panel to desk-ppd less than 8' DWAIN DELOACH Owner of Deloach Electric Inc. CITY O LA QUINTA BUILDING & SAFETY DEPT. 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