08-1171 (ELEC)14,
IIIIIIIIVIIIIIIVIIIIIII 15
IE
P.O. BOX 1504 -- - - - --
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001171
Property Address: 81187 AVENUE 52
APN: 767-200-998-U -330761-
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
Applicant:
l_
T4ht 4 �4 Q"
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 a rofessionals ode, and my License is in full force and effect.
Licensee Class: C10 ense No.: 510541
Dater Contractor:
OWNER -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 ISec. 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 or improves thereon, and who contracts for the projects with a contractor(s) 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:
LQPER111IT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
MARTINEZ ELEC
38455 BEL AIR
CATHEDRAL CIT
(760)321-2036
Lic. No.: 510
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
RON &
922344 ZQ�
lull 15
OF_,r•t.A QU1%TA
CITE . , e WEPT. —
Date: 7/15/08
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:
,Carrier EXEMPT 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 t came subject to the workers' compensation laws of California,
and agree that, if I should om2subject he workers' compensation provisions of Section
3700 of the Labor Cod shall fmply with those provisions.
Date: � l Applicant:
WARNING: FAILURE TO SEC Cod/
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 statethat the above i on
is corr . I agree to comply with all
city and county ordinances and state laws relating to building c ruction, and h by authorize representatives
of this county to enter upon the above-mentioned property f spection purp s.
���fff r �)� -
Date,X17-Signature (Applicant or Agent):
Application Number . . . . . 08-00001171
PermitELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33.50 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date . . 1/11/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A
18.50
----------------------------------------------------------------------------
Special Notes and Comments
INSTALLATION OF PERMENANT 200 AMP
ELECTRICAL PEDESTAL METER PE RAPPROVED
PLANS
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
LQPERMIT
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APPROVED BY:
CITY OF LA QUINTA
DRAVANG NAME
ADDRESS MAP
IMPROVEMENT PLANS
TRACT 33076-1&2
so. xao
9-0.E. Pn«W3.l3J ai'
consultants Inc.
EH•ADORESS MAP
PROJECT NI,
0001 MDC
SHEET OF
saa0 On Dg -P SCALE: FILE No.
REVISIONS DATE NO •,M, Br: O.G. 1.rt: ./)/aE ' 1'=150' 0502
MADISON CLUB
Bin #
Qty of La Quinta
Building 8F Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
I 9 Building Permit Application and Tracking Sheet
Permit # `
1
Project Address: ✓ 2 S
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: P0., / ' io `"I e e I Pc�(_ r
City, ST, Zip:
Telephone: 7(y 0
Address: _
gQ �; /
Project Description: I/% 5.
City, ST, Zip: // ���Qd (� ( }' i C_ /r q� `/
p
Telephone: ne: GO 1 a�
L� � ' r
. fi
State Lic.# : P
! o S`a l ;1' o City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
;; .; <:>::::;<;:::::::r:<»>: >;::>><:;:>:::
Construction Type:G I Zcf �: Occupancy:
State Lic.
Name of Contact Person: 5 �.;1 LSO
Project type (circle one): (Ir]�D Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 7 rio J 3 9f G 7L )'I
Estimated Value of Project: S_Cto
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
I 0
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n1 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' 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
• el-ts ? aim. 52
C iel:tif at 4 add..
P.O. BOX 1504 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: 7/24/08
• Application Number: 08-00001171 p Owner:
Property Address: 8:1 gn r^G- '? O 1 " J87 �,Gt,(, 5Z EAST OF MADISON LLC
APN: 767-200-998-A -330762- PO BOX 1482
Application description: ELECTRICAL LA QUINTA, CA 92247
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
Contractor:
Applicant: Architect or Engineer: MARTINEZ ELECTRIC, RON
38455 BEL AIR
CATHEDRAL CITY, CA 92234
(760)321-2036
,L— Lic. No. : 510541
ial
/ .
•
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: C10 License No.: 510541 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 EXEMPT Policy Number EXEMPT
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in the perfarmmtea of the work for which 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 become subject to the 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 should become subject to the workers'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 Code,I shall forthwith comply with 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($500).: Date: . Applicant:.
(_) 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 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($100,000). 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 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 Contractors'State License Law does not apply 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 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 License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( ) I am exempt under Sec. _,B.&P.C.for this reason 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: 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 1 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 construction,and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name:
Date: Signature(Applicant or Agent):
Lender's Address:
LQPERMIT
Application Number 08-00001171
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33 .50 Plan Check Fee . .00
Issue Date . . 7/15/08 Valuation . . . 0
Expiration Date . . 1/11/09
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
INSTALLATION OF PERMENANT 200 AMP
ELECTRICAL PEDESTAL METER PER APPROVED
PLANS
***BEFORE ANY WORK WAS DONE, THIS PERMIT
WAS RELOCATED TO THIS ADDRESS FROM
81-187 AVENUE 52.***
Fee summary Charged Paid Credited Due
Permit Fee Total 33.50 33 .50 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 33.50 33 .50 .00 .00
LQPERMTT
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