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78-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0046 10-44,
Property Address: 46080 JEFFERSON ST ST
APN: 600070012
Application Description: CONTOUR DERMATOLO P POIER
Property Zoning:
nn
Application Valuation: $5,000.00 MAY Il n
Applicant: J
S R BRAY LLC DBA POWER PLUS DESIGN AND "Ty()FLA QUINTA
1210 N RED GUM STREET DEIIELOPMENTDEPARTMENT
ANAHEIM, CA 92806
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
EJ LA QUINTA, LLC
42600 MIRAGE RD
RANCHO MIRAGE, CA 92270
Contractor:
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM STREET
ANAHEIM, CA 92806
(714)507-1881
Llc. No.: 980589
Date: 5/10/2017 /
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: B. C10, D31 License No.: 980589
of the work for which this permit is issued.
C /Q
I have and will maintain workers' compensation insurance, as required by
Date: J 1 Contract
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:
OWNER --BUILDER DECLARATION
Carrier: OLD REPUBLIC GENERAL INSURANCE CORPORATION Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
AICW37451700
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
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basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a'
Date: Applicant.
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' C NSATION COVERAGE IS UNLAWFUL,
(_) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(1 I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application , the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
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
Date: Owner:
work for 180 days will subject permit to cancellation.
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:
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 Agent):
Application Number:
BELC2017-0046
Property Address:
46080 JEFFERSON ST ST
APN:
600070012
Application Description:
CONTOUR DERMATOLOGY/ TEMP POWER
Property Zoning:
Application Valuation:
$5,000.00
Owner: .
EJ LA QUI NTA, LLC
42600 MIRAGE RD
RANCHO MIRAGE, CA 92270
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 1 ANAHEIM, CA 92806
(714)507-1881
Llc. No.: 980589
Detail: 100 AMP TEMP POWER TO FEED CONSTRUCTION TRAILER. PER 2016 CALIFORNIA BUILDING CODE
1
I
Date: 5/10/2017
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
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
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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Qty -cif ia. Quinta
Buifding a Safety Division
Permit #; . . 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Applikation and Tracking Sheet
Project Address:Q l S0(1 Owner's Name: , �LA 1 d e/ S
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Poll,C✓Tel
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eh one:
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Address:Description:
City, ST, Zip: S
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61 p - .
Telephone: q.SI �zo �
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State Lic. # :
City Lie.
Arch., Gngr., Designer:
Address:
City, ST, Zip:
Telephone.
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ons Type: Occupancy:cy
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Sla toL ic. #
Project type etcircle nNe Add'n Alter Repair- Demo.
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Name of Contact Person:
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Sq. Ft.:
# Stories:
#Units
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Telephone # of Contact Person: RJ I —J– yl (% b
Estimated Value of Project: • b
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rcc'd
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 Cates.
Plans picked up
Construction
Flood plain'plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jrd 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
heck A License - License Detail Page 1 of
Contractor's License Detail -for License # 980589
)ISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this
nformation, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the
link or button to obtain complaint and/or legal action information.
Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
Business Information
S R BRAY LLC
DBA POWER PLUS
1210 N RED GUM STREET
.ANAHEIM, CA 92806
Business Phone Number.(714) 507-1881
,
Entity Ltd Liability
Issue Date 01/24/2013
Expire, Date 01/31/2019
License Status
"his license is current and active.
►II information below should be reviewed.
Classifications i
B - GENERAL BUILDING CONTRACTOR
C10 - ELECTRICAL
C-61 / D31 - POLE INSTALLATION AND MAINTENANCE
Bonding Information
Contractor's Bond
'his license filed a Contractor's Bond with NORTH AMERICAN SPECIALTY INSURANCE COMPANY.
3ond Number: 2204158
3ond Amount: $15,000
:ffective Date: 01/01/2016
;ontractor's Bond History
LLC EMPLOYEE/WORKER BOND
'his license filed a LLC Employee/Worker Bond with NORTH AMERICAN SPECIALTY INSURANCE COMPANY.
3ond Number: 2204157
3ond Amount: $100,000
:ffective Date: 01/01/2016
.LC Employee/Worker Bond History
Bond of Qualifying Individual
The qualifying individual STEVEN RONALD BRAY certified that he/she owns 10 percent or more of the voting stock/membership
interest'of this company; therefore, the Bond of Qualifying Individual is not required.
Effective Date: 01/24i2013
tps://www2.cslb.ca.gov/OnlifteServices/CheckLicenseII/LicenseDetail.aspx?LicNum=980589 5/10/20
heck A License - License Detail Page 2 of
Policy Number:AICW37451700
Effective Date: 03/31/2017 t
Expire Date: 03/31/2018
Workers' Compensation History
Liability Insurance Information
This license has liability insurance with OLD REPUBLIC GENERAL INSURANCE CORPORATION
Policy Number: AICG37451700
Amount: $2,000,000
Effective Date: 03/31/2017
Expiration Date: 03/31/2018
Liability Insurance History
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