09-0848 (ELEC)P.O. BOX 1504-
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
IN p
Application Number: ,=O'9MI60.000848
Property Address: 56060 RIVIERA
APN: 762-021-004- -
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1200
Applicant:
.Architect or Engineer:
BUILDING & SAFETY .DEPARTMENT
BUILDING PERMIT
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, a d my License is in full force and effect.
License Class: C10 ce 0 717777
D�Contractor:
OWNER -BUILDER DECLARA�ON
I hereby affirm under penalty of perjury that,l am exempt from the Contractor' license law for the -
following reason (Sec. 7031 .5, $usiness and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demoli-V.r 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 70001 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 1 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 town 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 1 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 construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERAIIT
Owner:
BABIC, EVA
56060 RIVIERA
LA QUINTA, CA 92253
(
Contractor:
HILL ELECTRIC INCORPORA
78670 HIGHWAY 111., SUIT
LA QUINTA, CA 92253
(760)772-1770
Lic. No.: 717777"
WORKER'S COMPENSA w..,�a.u.�.. w�.
I hereby affirm under penalty of perjury one of the following declarations:
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 the work for which this permit is
issued.
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
insurance carrier and policy number are:
Carrier DELOS INS Policy Number 01DKRM22005804
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 wor s' compensation provisions of Section
3700 of the La -boar C de shall f rt ith o ply it hose provisions.
C_Date. !Iprc.nt:; /
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 1$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 Director of Building and Safety 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, agent's 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 here uthorize representatives
of this county to enter upon the above-mentioned prop@rty or ins n p rp e
Date: 3�OS O�gnatu a
cant, or -Agent):
a
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/05/09
f
LQPE"11T
Application Number 09-00000848
Permit . . . ELEC-SERVICE
CHANGE'
Additional desc .
Permit Fee 33.50
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date 2/01/10
' Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC.SVC
<=600V/<=200A
18.50
------------
Notes and Comments
- ------------------------------Special
CHANGE OUT EXISTING 200 AMP PANEL
TO NEW
200 AMP PANEL.
-
-------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
--------------
1.00
Fee summary Charged -Paid
Credited
Due
Permit Fee Total 33.50
.00 .00
33.•50
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total_.. 34.50
.00 .00
34.50
LQPE"11T
I
Bin
Qty of La Quinia
Building 8T Safety Division
P.O. Box 1504, 78 -495 -Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Appikation and Tracking Sheet
Perm
# e
Project Address:
5(n_(%0 V I er.(a
Owner's Name:
A. P. Number:
Address: s(O-oGn
Legal Description:
City, ST, Zip: CA
Contractor:Vk
Telephone:_ 11111
Address --70
I III *14q
Project Description:.
Pity', ST, Zip:
Telephone'/b0" na- I
f)05i1 1200.
W 42 MLL( ME -200
State Lie. # : -71
City Lie. C
I
IAI On&d
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lie. ....... ........
Name of Contact Person:
Construction Type: Occupancy:
Project t . ype (circle one: New Aden Alter Repair Demo
10
Sq. Ft.:.1�0G
#.Stories:,
9 Units:
Telephone # of Contact Person: 7e) - nq 32,_ -
Estimated. Value of ProjetR ?C0
APPLICANT: DO NOT WRITE. BELOW THIS LINE
N
Submittal
Req7d
IlWd
TRACH.ING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount'
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Che.:k Balance.
Title 24 Cales.
Plans picked tip
Construe -don
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing;,
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading:
IN HOUSE:-
Rcyiew,ready'Cor corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Pt:rmit Fees