BELC2020-0005OWNER -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).:
(_) 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,).
(_) 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
78-495 CALLE TAMPICO D1�,+(ilJ VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/23/2020
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number: BELC2020-0005 ALEXANDER & JULIE SHEFTS
Property Address: 77655 CALLE POTRERO 77655 CALLE POTRERO
APN: 774302011 LA QUINTA, CA 92253
Application Description: SHEFT / 200AMP ELECTRICAL SERVICE UPGRADE
Property Zoning:
Application Valuation: $1,000.00
Applicant: ❑
pP � Contractor:
H E S HERRERA ELECTRIC SOLUTIONS D H E S HERRERA ELECTRIC SOLUTIONS
83185 ALBION AVENUE A A� 3 �O�O 83185 ALBION AVENUE
AN
INDIO, CA 92201 INDIO, CA 92201
CITY OF LA OUINTIA (760)391-0768
DESIGN & DEVELOPMEN 1 DEPARTMENT Llc. No.: 1013467
----------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and _ I have and will maintain a certificate of consent to self -insure for workers'
my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C10 License No..1013467 of he ork for which this permit is issued.
`` 1t t r I have and will maintain workers' compensation insurance, as required by
Date: 1—�� Contractor V V M tJ� 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: Policy Number: 47 4
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. .��+�'pr�y
Date: . - 20 Applicant:_ - i �-'r• 1 R
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 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.
Dater Signature (Applicant or Agen
Date: 1/23/2020
Application Number:
BELC2020-0005
Property Address:
77655 CALLE POTRERO
APN:
774302011
Application Description:
SHEFT / 200AMP ELECTRICAL SERVICE UPGRADE
Property Zoning:
Application Valuation:
$1,000.00
Applicant:
H E S HERRERA ELECTRIC
SOLUTIONS
83185 ALBION AVENUE
INDIO, CA 92201
Owner:
ALEXANDER & JULIE SHEFTS
77655 CALLE POTRERO
LA QUINTA, CA 92253
Contractor:
H E S HERRERA ELECTRIC SOLUTIONS
83185 ALBION AVENUE
INDIO, CA 92201
(760)391-0768
Llc. No.: 1013467
Detail: 200A ELECTRICAL SERVICE UPGRADE [100A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2019 CALIFORNIA
BUILDING CODES.
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PERMIT 11 �I� �f� � � `� Q � ()o —
PLAN LOCATION:
Project Address: 0s C U
V k�b
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
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geley wh-J �Vovo
Applicant Name-
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Address: ^ 1^e U ��
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City, ST, Zip:
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Telephone:
Email:
Valuation of Project $ I V C1
Contractor Name:
(Dv� vkQjv
Address: 8-:m S
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City, St, Zip
C p\ n 7
Telephone l bO
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Email:
State Lic 1 3�
City Bus Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
City Bus Lic:
Property Owner's Name: Aex m
Address: � u L 1 1-A• S
City, ST, Zip:IJ P yi v
Telephone: �CA C 2,s
Email:
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction Type:
Grading:
Bedrooms: I Stories:
1
SF
SF
SF
Occupa
# Units:
New Commercial / Tenant Improvements:
Total Building
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
SF
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00