07-0652 (ELEC) e,„
+
P.O. BOX 1504 U I ft 1 LI
VOICE(760) 777-7012
78-495 CALLE TAMPICO FAX(760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760)777-7153
BUILDING PERMIT
Date: 3/01/07
Application Number: 07-00000652 Owner:
Property Address: 52433 AVENIDA VILLA BARAJAS LARRY PAUL
APN: 773-273-024-10 -000000- 52433 AVENIDA VILLA
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL •
Application valuation: 40
Contractor:
Applicant: Architect or Engineer: Owner A
1 MAR 0 12007 ./
CITY OF LA QUINTA
FINANCE DEPT.
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000)of Division 3 of the Business and Professionals Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
License Class: License No.: for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
Date: Contractor: _ 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
OWNER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to A. I certify that,in the performance of the work f• • this permit is issued,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any manner so as to,,•+• a: •duct to e workers'compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I shoul. •,come sti•. 0 the •rkers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the Labor Co•=,I shall fort with co pl Ith those provisions.
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 IS5001.: Date:3— I-- 0/Applicant: -�
(X0 I I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and 11.1111111.P.-
the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,provided that the DOLLARS 0100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
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.). • APPLICANT ACKNOWLEDGEMENT
) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Cont=.«% _' - =e License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,an. • • the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State Licen-.., ;, whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I_I I am exempt under Sec. .. P.C. or this r•,.• 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.
Date: - d / /Owner: rt 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 c- • of work for 180 days will subject
• CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state th. . ... • .ormation lx cor act- I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.I. city and county ordinances and state laws relati•,to building can•ru ..n,and he"•by authorize representatives
of this county to enter upon the above-menti• ed property for in-.•ction• rpos=-.
Lender's Name: Date:3—f O'>Signature(Applicant.r Agent): __ft
Lender's Address:
LQPERMIT
Application Number 07-00000652
Permit ELEC-SERVICE CHANGE
Additional desc .
Permit Fee . . . 33 .50 Plan Check Fee . . .00
Issue Date . . . Valuation . . 0
Expiration Date . 8/28/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
REPLACE 2 BREAKERS/REPLACE COVERS &
RETURN SERVICE PANEL TO ORIGINAL
CONDITION/
Fee summary Charged Paid Credited Due
~' Permit Fee Total 33 .50 .00 .00 33.50 .
Plan Check Total 00 .00 .00 .00
Grand Total 33.50 .00 .00 33.50
LQPERMTT
Bin#
City of La Quinta
Building ex Safety Division
Permit# -1 P.O. Box 1504, 78-495 Calle Tampico
C/r! La Quinta, CA 92253- (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: —�
A.P.Number: , Owner's Name: v �i c��r c j L�S
Address: S 3 3 4U evz« 4 Li' 11a_
Legal Description:
City,ST,Zip:
Contractor. /iL C� t (� rt f c, _
Telephone:( '1 S') — 6 s . �i: °f
Address. _ 3 ...
' Project Description:
City,ST,Zip:
Telephone: f: r •.x's.fi.. /Ct t - _� C aL t c..< < �:Ic,-r L t •
State Lie.#. -: >.'', `'' '- .YL ,q-a ? vt F, c o t>'€f t 5 c - •
, City Lic.#:
Arch.,Engr_,Designer:
Address:
•
City,ST,Zip: i
Telephone: = ..^x = • • .
,_ } - `.- :r nstruction Type:
State Lie.#: -_ •.ti�_ � Occupancy:
= J type(circle one): New Add'n Alter Repair Dane
• . Name of Contact Person:
Sq.Ft.: : [ #Stories: I #Units:
Telephone#of Contact Person: Estimated Value of Project: VO —r
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rec'd TRACKING
^� PERMiT FEES
Plan Sets Plan Check submitted •
r- Item Amount
Structural Calcs. , • Reviewed,ready for corrections Plan Check Dep
osit
Truss Calcs. Called Contact Person
Plan Check Balance
Energy Glcs. Plans kicked up
Construction
Flood plain plan Plans resubmitted
Mechanical
Grading plan' Z"Review,ready for corrections/�ssae a
_• Electrical
Subcontactor List • Called Contact Person
Plumbing
Grant Deed Plans picked up
S.M.L
R.O.A.Approval Plans resubmitted
Grading
IN HOUSE:- '"Review,ready for correctionsrissue Developer Impact Fee
l Planning Approval Called Contact Person
A.LP.P.
Pub.Wks.Appr Date of permit issue
School Fees
Total Permit Fees