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BELC2019-006478-495 CALLE TAMPICO Ct 0 D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: ELECTRICAL/ Application Number: BELC2019-0064 Property Address: 79675 HIGHWAY 111 APN: 600020053 Application Description: MARMOT / TEMPORARY ELECTRICAL SERVICE TO CONST. TRAILER Property Zoning: Application Valuation: $2,500.00 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: RESIDENCE INN BY MARRIOTT 79675 DUNE PALMS ROAD Applicant: Contractor: S R BRAY LLC DBA POWER PLUS S R BRAY LLC DBA POWER PLUS 1210 N RED GUM STREET F 1210 N RED GUM STREET ANAHEIM, CA 92806 ANAHEIM, CA 92806 JUN 10 2019 (714)507-1881 Llc. No.: 980589 crroF L�;�u!���Ta DESIGi l DEVELOP P.iENT DEPARTP-f ENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: B. C10, D31 License N Date: _ i� �rr3` Contractor: Z7!_ 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, 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.). (_) 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 Ad Date: 6/10/2019 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 rk For which this permit Is issued. I have and will maintaln workers' compensation insurance, as required by SeW Y3700 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: FEDERAL INSURANCE COMPANY Policy Number:54309652 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. vi Date: / Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPEN ON 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: 'w._l Signature (Applicant or Agent): Date: 6/10/2019 Application Number: BELC2019-0064 Property Address: 79675 HIGHWAY 111 APN: 600020053 Application Description: MARMOT / TEMPORARY ELECTRICAL SERVICE TO CONST. TRAILER Property Zoning: Application Valuation: $2,500.00 Applicant: S R BRAY LLC DBA POWER PLUS 1210 N RED GUM STREET ANAHEIM, CA 92806 Owner: RESIDENCE INN BY MARRIOTT 79675 DUNE PALMS ROAD Contractor: S R BRAY LLC DBA POWER PLUS 1210 N RED GUM STREET ANAHEIM, CA 92806 (714)507-1881 Llc. No.: 980589 Detail: MARRIOTT / TEMPORARY POWER SERVICE ONLY FOR TEMPORARY CONSTRUCTION TRAILER (TRAILER PER SEPARATE PERMIT). (8) POWER POLES W/OVERHEAD CONDUCTORS TO SUPPLY 200A TEMP. SERVICE. 2016 CALIFORNIA ELECTRICAL CODE. 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 $26.68 DESCRIPTION ACCOUNT CITY AMOUNT TEMP POWER SERVICE PC 10170000-42600 0 $18.68 Total Paid for ELECTRICAL: $45.36 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 HIGHWAY i l i & DUNE PALMS ROAD 1 1711j a To v"N JYM ?I PROPOSED NEW BUILDING ,I SLL ANCIII ILCTUNAI,{7AN51 ON BUh DWG DIVENSIONSI ............... PORTER CONSTRUCTION yv 6Q,6 I L::� � � II ' >>�£ CITY 4NG INT Is r BUILION RE-'.VIEWFOR �'"� Foe CONST E ` 1 c i�20ATB + � . vasej&c- 2 #L cec- 4t4t#T ,e&t;vJ,eE+#GArrs.MJ { y 0 U/G COMM U\'1173514F L��� LA QUINTA bs Architect/Engineer Name: Construction Occupancy: Address: Grading: City, St, Zip Telephone: Email State Lic City Bus Lic: Property Owner's Name: Address: 72- 5 City, ST, Zip Telephone: Email: Bedrooms: I Stories: # Units: New Commercial / Tenant Improvements: Total Building SF Construction Type: Occupancy: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 4 Ac"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/31/2020 3/12/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #OF 15767 Los Angeles CA 90017 (213) 689-0065 INSURER A : AFFORDING COVERAGE NAIC # 35181 INSURED SR Bray, LLC dba Power Plus! INSURER B: Feder Insuranceom an 20281 1392947 1210 N. Red Gum Street INSURER C : Starr Indemnity & Liabilfty Company 38318 Anaheim CA 92806 INSURER D : Indian Harbor Insurance Co!npany 36940 INSURER E : Chubb National Insurance Company 10052 INSURER F COVERAGES SRBRA01 CERTIFICATE NUMBER: 1I205174 REVISION NUMBER: Xxxxxxx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTRR ADDITYPE OF INSURANCE INSD WVD POLICY NUMBER MMILIb EFL MMIDD POLICY E%P LIMA IYYYI A E X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N N 54309650 Ol (AOS) 5430965101 (CT) 3/31/2019 3/31/2019 3/31/2020 3/31/2020 EACH OCCURRENCE $ 1,000,000 $ 300,000 DAMAGE TO RENTED PRIrMISES Eaaoauler_�_xej MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG s 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N 54309649 3/31/2019 3/31/2020 CEOeMBBIIN D SINGLE LiMI $ 1,000,000 x BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $� XXXX�� PROPERTY DAMAGE Per ac ' . t $ XX Cornnfoll Ded $ 1,000 C UMBRELLA LIAB EXCESS LIAB x OCCUR CLAIMS -MADE N N 1000585672191 3/31/2019 I ! 3/31/2020 EACH OCCURRENCE $ 5,000,000 x AGGREGATE $ 5,000,000 DED I RETENTIONS $ XxXxxxx B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICER/MEMBER PARTNE /E ECUTIVE Fy]N EXCLUD(Mandatory In NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below / A N 54309652 01 3/31/2019 3/31/2020 X STOAT T ER E.L EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1.000.000 E.L. DISEASE - POLICY LIMIT $ 1 OOO )00 D Pollution Liability N Professional Liability N PECO01452401 f f 3/31/2019 3/31/2020 Each Claim/Aggregate: $5,000,000 Each Claim/Aggregate: $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence of Coverage LCR! It -I I..M 1 C!'TVLLCR 4HNl..CL.I..Fi] tVN 11205174 Evidence of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ACORD 25 (2016/03) ©1988-201MMCaFt❑ CORPORATION. All riahts reserved The ACORD name and logo are registered marks of ACORD