12-1242 (ELEC)4
P.O. BOX 1504 VOICE (7) 777-
78-495 CALLE TAMPICO FAX (760 - 011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/17/12
Application Number: 12-00001242 Owner:
Property Address: 78121 AVENIDA LA FONDA GRIFFITH INV.
APN: 770-122-017- - - 1301 ALASKAN WAY
Application description: ELECTRICAL SEATTLE, WA 98101
Property Zoning: VILLAGE COMMERCIAL
P
Annlication valuation: 500
Contractor: OCT 2 2 2012
Applicant: Architect or Engineer: MC LELLAN, SCOTT 1
]0
229 W. MARQUITA UNIT A
SAN CLEMENTE, CA 92672 CITY
I IFNPN EDE TOF LA TA
L+� (949)291-0913
�— Lic. No.: 427358
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 Professionals Code, and my License is in full force and effect.
License Class: B License No.: 427358
�Date:/()--1+Z_ 2.6ontractor: -
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).:
1 _ I 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
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 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:
LQPERMIT
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 EXEMPT Policy Number EXEMPT
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 Coclej shall forthwith comply with those provisions.
Date: I 7� Z- I2 ,Applicant: C __
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 Director of Building and Safety 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 county to enter upon the above-mentioned property for in pection purposes. _
Date: (Applicant or Agent): c444
Application Number . . . 12-00001242
Permit ELEC-MISCELLANEOUS
' Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee
11.25
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/15/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA ELEC PWR APP >50 TO <=100
30.00
Special Notes and Comments
100AMP SUBPANEL INSTALLATION FOR BETTER
DISTRIBUTION OF KITCHEN LOADS. ADDENDUM
TO EXISTING COMMERCIAL ADDITION PERMIT
NUMBER 12-0689, FOR THE PURPOSES OF
DETERMINING PROPER CONTRACTOR STATE
LICENSING. 2010 CALIFORNIA ELECTRICAL
CODE.
October 17, 2012 3:18:07 PM AORTEGA
-=--------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary. Charged Paid Credited
------------------------------
Due
---------------------------
Permit Fee Total 45.00 .00 .00
45.00
Plan Check Total 11.25 .00 .00
.11.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 57.25 .00 .00
57.25
LQPERMIT
Bin. #
�a,d�s• fwd -12. ..it1 r 6f-.La Qui.(l.td
BLdk lg 8z Safety Division
P.O. Sox 1504,-78-495 Calle Tamploo
1.a.Quinta, CA 92233 - (760) 77T7012
Building Permit Application and Tracking Sheet
Permit #
I� •!2'�2
Project Address: g l �a
Owner's Name:. s
A. P. Number. 7 7 O��.� _ O I
Address: 13 O 1
Legal Description:
Contractor. co-4- M G • 2
City, ST, Zap:
Telephone: Y
Adm: Q
Project Description: a.
City, ST, Zip: Sa C e 4 Cl� 0 a e_
Telephone:
0 1 s
State Lia # : City Lie #; p
10c, A
Arch., Engr , Designer
u ro
Address:
?L "' '>
City., ST, Zip:
Telephone:
Construction Type:. Oocupaney:
Project type (circle one): Newdd' Alter Repair Demo
State Lie. #:
Name of Contact Person: j� f
-Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person: C1 C - r( - O j
Estimateil Value of Project <�(� ,
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERM F FEES
Plan sets
Pian Cheek submitted-
Item Amount
Structural Coles.
Reviewed, ready for cortrctions
Pian Check Deposit. .
T Toss Coles.
Called Contact Person
Plan Check Balance
Tide 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
71 Review, ready for correctiouslissue\11Electrical
Snbcontactor List
Called ContactPerson
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Ds° Review; ready for oorreetio
Developer Impact Fee
Planning Approval.Called
Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees