13-1602 (ELEC)P.O. BOX 1504 VOICE -(760) 777-7012
78-495 CALLE TAMPICO tN�•--�� FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: ,12/11/13
Application Number:_ _13-0DL00-16-0:2, Owner:
,Property Address;.!��52790. M� IDA OBREGON CATHY CUNNINGHAM
APN: 773-315=024-4 —'000000= 52790 AVENIDA OBREGON
Application description: ELECTRICAL CATHEDRAL CITY, CA 92235
Property Zoning: COVE RESIDENTIAL (714)600-1981 -
Application valuation: 1500 D
Contractor: y
Applicant: Architect or Engineer: HARTMA.ELECTRIC IN ECD FC `� 1 "2013'
N.
P.O. BOX. 1427
LA QUINTA, CA 92247 Ct1'YO�IA(dUIR1iA
�� (760) 831-0664 FIfdANCEDEpT.
` Lic. No.: 898575
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter'9 Icommencing 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. AC
I have and.will maintain a certificate of consent to self -insure for workers' compensation, as proviLicensia'Class C10 •e se No : 8575- or.by Section 3700 of the Labor Code, for the performance'of the work for which this permit is
Date*.— Contractor- '- ve and -will maintain workers;�compensation insurance as required by Section 3700 of. the Labor
ode for.the performance of the wo.k:for which this ' rmitis issued. My workers"compensation
` OWNER -BUILDER DECLARATION' ` s insurance carrier and policy number are:
,66
I hereby: affirm under penalty of perjury that I am exemptfrom'the-Contractor's:State License Lawfor. the Cartier HFiRTFORD Y.INS . 'Policy Number 76 • WEG DR7560; - _ -
following reason(Sec. 7631.5; Business,and Professions Code: Any cny oi,county thatrequires a permit to _ I certify'that.'in°the performance�of the work`for which this permit is issued;,) shall not -employ. any
construct, alter, improve, demolish or repair, any structure; prior to its issuance also requires the applicant for the. person in nymme
annet so as to becosubjeci'6 the workers' compensation,laws'of'Califoinia,
permit to file a signedstatemenY.that he•or she is licensedpursuant aothe; provisions oY_the ContractorFs State a ono agreethat, if I should become subtect.to the workers' compensation provisions: of Section^•
License Law (Chapter9 )commencing with Section 7000) of Division 3 of'the.Business'and Professions.CoaeYor - 3700"6f the -Labor Code, I shall forthwith comply -with th_bseprovisions. - that he,or she is -exempt therefrom and the basis for the alleged exemption: Any violation of Section.7031.5' by
any applicant for apermtl sublectsthe:applicant to'a civil penaltyof,not moFethan fnre.hundred,dollars ($5001.: - r� Date Applicant: ✓'` f-/'FHGL�i� GIGO/ '/V�• '
.,• 1 P I,:asownerof,.the propertyror my employees wiih wages:as their sole compensation willdo the -work, and
.. "'. thestructure is.not'intended:or.'offereil forsale.ISeC 7,044^BusinessanGYrofe-ssionsCode?•.The - ...WARNING: FAILURE TO LURE E. WORKERS' COM PENSATION:COVERAGE-IS UNLAWFUL, ANDSHALL'
Contractors_State.License,Law;doesnorapply to an' -owner ofpioperty who tiudds or.improvesthereon,. .. SUBJECT AN'ENIPLOYER T&CRIMINAC.PENALTIES AND CIVIL.FINES uP•TO ONE HUNDRED THOUSAND
_ t .., - -
and who does the work himself of herself through his or nerown'employeesrprovided that,the 'd ° _
DOLLARS 1$ 100,000). IN ADDITION TO THE COST OF COMPENSATION,:.
PROVIDED FOR IN
improvements;are,not intended oroffered for sale. If, however,.thebuilding or impiovement'is sold within SECTION 3706 OF THE LA80R CODE, INTEREST., AND ATTORNEY'S FEES.
one year of'compleiion, the owner -builder will have the burden of proving that.he or she didnotbuild or
improve for the purpose of sale.): ' •`• - ;,� "` • ' `APPLICANT ACKNOWLEDGEMENT- -
_ 1A as owner.of t6epropeny;,am.exclusively- contracting =with licensed7contracfors to-construcrthe project (Sec. IMPORTANT Application is hereby made,to,ihe Director of'Building anid Safety for a permit subject•to-the
7044, Business and .Professions Code: The Contractors' State License Law.'does nonapply to an owner of conditions and restrictions set, forth on,this application.
property who builds or improves thereon, and.who contracts for the projects with a contractorls) licensed. 1. Each -person upon whose behalf this application is made, each person ai`whose request and for _
pursuant to,theContractors'. Sta;e License Law.). - whose benefit work is performed under or pursuant to anypermit issued as a result of this application,
I_) I am exempt under Sec. B.&P.C. for this reason the owner, and 'the applicant, each agrees to, and shall defend, indemnify ani) 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: Owner: 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
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 that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building structio and authorize representatives
of this county to enterupon the above-mentioned propert nspec ' - es
Lender's Name:
Date: �G �l� Signature (Applicant it
Ag ):
Lender's Address: `" - -
LQPERMIT
Application Number 13-00001602
Permit . . . . . . ELECTRICAL 2013
Additional desc .
Permit Fee . . . . 23.83
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 6/09/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC SERVICES
23.83
----------------------------------------------------------------------------
Special Notes and Comments
ELECTRICAL - PANEL CHANGE OUT, SAME
LOCATION. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
PLAN
CHECK, ELECTRICAL
11.92
PERMIT
ISSUANCE M/P/E
90.57
Fee summary Charged Paid
-------------------------------------
Credited
-------=--
Due
Permit Fee Total 23.83
----------
.00 .00
23.83
Plan Check Total .00
.00 .00
.00
Other Fee Total 103.49
.00 .00
103.49
Grand Total 127.32
.00 .00
127.32
LQPERMIT
Qin #
.0ty. of La 'Qulnta
Building 8t•'Safety Division
P.O. Box 1304, 78=495 Ca1(e Tampico
La Quinta; CA 92253 (760) 777-7012
Building Permit Application -and Tracking Sheet
Permit #
Project Address: 5�) 7Cj(D o j3 R—E6, O A/
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:Telephone:'
2C� � A �I mH a/ ��( t=C`�f�,� G�;-1.
•.�`�f>?�:'•�>
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Address: 0 'Bo'f— (C F -7
Project Description:'
COAnJGE 00 11
City, ST, zip: t4 01',J 1,4 (!,4
Tele hone: — ,L
7 60 T
'? <
{{ O YV� �
E � [:` S 1
d
U 1
A.
State Lic. # : get g 5. 7 S
'City Lie. #:
NEA—( 2 )'V1
Arch., Engr., Designer:
Address:
.City., ST, Zip:
a
Telephoner
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<'h<.>;;:'.:>,:::.':•>>:<;:;,.,::%`_::"sz:
.: .....:.:::.....::.<.
rr Construction Ty e: P,Cpk Occu anc : Y6C
State Lic. #:
,
;Project type one): New Add n Alter Repair Demo
Name of Contact Person:
'Sq-Ft.:
#'Stories:
#Units:
Telephone #,of Contact Person:
Egtirfikdd Value of.Project:. QD
r
APPLICANT: DO NOT WRITE BELOWj,,"IS. LINE
#
Submittal
Req 'd
Recd
TRACKING ?
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount.
Structural Calcs.
Reviewed, ready for corrections
'flan Check Deposit
Truss Calcs.
Called Contact Person'
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°° Review, ready for corrections%issue
Electrical
Subcontactor List
Called Contact Person
Plumbing,
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted'.
`Grading
IN HOUSE:-
'^' Review, ready for'correctionsrissue
Dcveloper. Impact Fee
Planning Approval
Called Contact Person-
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
i
`TotalYermit Fees
Jr •
d