BELC2020-000278-495 CALLE TAMPICO TihO/ D 64� Quiftg) VOICE (760) 777-7125 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/6/2020
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number: BELC2020-0002 JUBIN SHARIFI
Property Address: 44615 SAFFRON CT 44615 SAFFRON CT
APN: 604252028 LA QUINTA, CA 92253
Application Description: SHARIFI / MAIN PANEL CHANGEOUT
Property Zoning:
Application Valuation:
Applicant: u Contractor:
Z
GRAYCO ELECTRIC INC GRAYCO ELECTRIC INC
P 0 BOX 13311 P 0 BOX 13311
PALM DESERT, CA 92255 .BAN 0 6 2020 PALM DESERT, CA 92255
(760)250-0467
ITV OFi-.i11�!(�JrGI Llc. No.: 977951
C `ILN L :SJki OR±VEN i DEPARTMENT
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: CIO( License No.: 7
Dater �� M Contractor:
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 ($S00).:
(_)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 N
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I he y a#irm under penalty of perjury one of the following declarations:
I have and will maintain a certificateof consent Lo self -insure for workers'
com nsation, as provided for by Section 3700 of the labor Code, for the performance
of t ork far which this permit Is issued.
I have and will maintain workers' compensation insurance, as required by
Sec 3700 of the Labor Cade, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: IVEREST PREMIER I A C A NPv Policy Number:
_ I certify that in the performance of the work for which this permit is issued,
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, i oufd become subject to the
workers' compensation provisions of Section 37 the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:4977
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 infor on is correct.
I agree to comply with all city and county ordinances and state laws ting to building
construction, and hereby authorize representatives of this city to upon the above -
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent)
Date: 1/6/2020
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GRAYCO ELECTRIC INC
P0BOX 13311
PALM DESERT, CA 92255
BELC2020-0002
44615 SAFFRON CT
604252028
SHARIFI / MAIN PANEL CHANGEOUT
Detail: REPLACE 200 AMP MAIN BREAKER. PER 2019 CALIFORNIA BUILDING CODES
Owner:
JUBIN SHARIFI
44615 SAFFRON CT
LA QUINTA, CA 92253
Contractor:
GRAYCO ELECTRIC INC
P0BOX 13311
PALM DESERT, CA 92255
(760)250-0467
Llc. No.: 977951
FINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT CITY
AMOUNT
RE -INSPECTION FEE
101-0000-42400 0
$80.50
Total Paid for ADMINISTRATIVE:
$80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
TOTALS:
$5.00
ta Q�dwra
PERMIT #
PLAN LOCATION:
Project Address:
/
l
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
/A
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Applicant Name:
Address:
City, ST, Zip:
Telephone:
Email:
Valuation of Project $
Contractor Name: 66� fle 1C, & (
,New SFD Construction:
Address: 7 7 S,�O /h Sk ` 1
Conditioned Space SF
City, St, Zip Pg(M ����� C� 9 71
Garage SF
Telephone: 70 3(o 9'0(
Patio/Porch SF
Email: avl ✓07 (' C —e(eCh, C +�
e
Fire Sprinklers SF
State Lic: �7�G�s% City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories: # Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: V I kiSh'-;
��
Address: l New Commercial / Tenant Improvements:
]� _ Total Building SF
City, ST, Zip , Construction Type: Occupancy:
Telephone: ' �
Email: �
CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000