13-0638 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000638
Property Address:
56405 RIVIERA
APN:
762-022-005- -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Appllca5on valuation:
2000
c&ht 4 4 4".
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
THOMAS MCDANIEL
19601 MAYFIELD CIRCLE
HUNTINGTON BEACH, CA 92648
(.
Applicant: Architect or Engineer:
----------------- I
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 Prof U sionals C and my License is in full force and effect.
License Class: C10_ ��" Li ns o.: 834921
gate �Ctrac (✓
®' OWNER -B LDER 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.).
(_ 1 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 orimproves thereon, and who contracts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 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 a 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:
LQPERMIT
Contractor:
MC DONALD, MICHAEL
45980 VIA LA COLORADA
TEMECULA, CA 92592
(951)297-0760
Lic. No.: 834921
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/20/13
MAY 2p 1013 �1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: -
I 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.
_ 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
insurance carrier and policy number are:
CarrierEX PT Policy Number EXEMPT
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, ifLshould becom subject to the workers' compensation provisions of Section
3700 of the Labor Code II sh hwit mply with those provisions.
at
De: p Iicant:�
77�� cr
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 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, 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 con ction, hereby authorize representatives
of this co u ty to enter upon the above mentioned proper for i p c[io ses.
Date:�7 Signature'(Applicant or Agent)
v�
Application Number 13-00000638
Permit ELECTRICAL 2013
Additional desc
'
Permit Fee '23.83 Plan Check Fee
.00
Issue Date . . . . Valuation.
0
Expiration Date'. 11/16/13
Qty Unit Charge Per
Extension .
1.00 23.8300 EA ELEC SERVICES
23.83
Special Notes and Comments
ELECTRICAL - MAIN SERVICE PANEL
REPLACEMENT (2010 CALIFORNIA BUILDING '
CODES)
----------------------------------------------------------------------------
Other Fees . . .. . . . . .. BLDG STDS ADMIN (SB1473)
1.00
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 91.57 .00 .00
91.57
Grand Total 115:40 .00' .00
115.40
Bfn.#
Qty of La Qulnta
Bulklity 8L Safety DW6n
P.O. Box 1504,78-495 Calle Tampico
la.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/
J
Project Address: nn—rob,c
'
Ownu sName:. /%% ►iii
A. P. Number.
Address: .S'(j�f p�' NVf�►s;
Legal Description:
City, ST, Zip: LA cilnii� �/o�„Z S3
Contractor
Telephone: "•�
Address: 7 -Mo V/j 11, (U,
Project Description:
City, ST, Zip:�P�heCvl4 �'i1�j"LW'i
�Crr� ce !fie !fie /'cusp-�..- <Z�✓i
y
Telephone: 7,5'1-;),67-0760 "Cs z
Stats Lic. # : 3 City Lie'. k
Arch., Engr:, Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft : Stories: #Units;
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd'Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates,
Called Contact Person
Plan Check Balance
Tule 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted..
Mechanical
Grading plea
2'! Review, ready for correctioneiissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
&NLL
A.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"° Review; ready for corrections/issue
Developer Impact Fee
Planning Approval"
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees