BSPN2016-006478755 Lowe Dr
BSPN2016-0064
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BSPN2016-0064
Property Address:
78755 LOWE DR
APN:
604233001
Application Description:
TWRIDT RESIDENCE / BREAKER CHANGE OUT
Property Zoning:
Application Valuation:
$600.00
Applicant:
BENDTSEN ELECTRIC
49605 MAGNOLIA DR
MORONGO VALLEY, CA 92256
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 1
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C10 License No.: 525981 B
LLe: / I2ol 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 ) 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 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.).
I ) 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
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/21/2016
PI
YLONTA, .2
NOV 21Z016
DESIG ontr LftQ
ryTA
49605 -rvl
MORONGO VALLEY, CQMENT
(760)459-9011
Llc. No.: 525981
WORKER'S COMPENSATION DECLARATION
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'
:ompensation, as provided for by Section 3700 of the Labor Code, for the performance
A the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
lection 3700 of the Labor Code, for the performance of the work for which this permit
s issued. My workers' compensation insurance carrier and policy number are:
-arrier: EXEMPT Policy Number: _
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
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
r
r ' —&mV Applicant:
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 Building Official 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
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
/ r
Date_.1 / KWW__ ture (Applicant.or,Agent):
Owner:
WOODY TWRIDT
78755 LOWE DR
LA QUINTA, CA 92253
Contractor:
BENDTSEN ELECTRIC
49605 MAGNOLIA DR
MORONGO VALLEY, CA 92256
(760)459-9011
Llc. No.: 525981
Date: 11/21/2016
Detail: PANEL REPAIR AND CHANGE OUT 125 AMP MAIN BREAKER, (1) 40 AMP TO POLE BREAKER, REPLACE (1) 2 POLE BREAKER. PER 2013 CALIFORNIA
BUILDING CODE
Application Number:
BSPN2016-0064
Property Address:
78755 LOWE DR
APN:
604233001
Application Description:
TWRIDT RESIDENCE / BREAKER CHANGE OUT
Property Zoning:
Application Valuation:
$600.00
Applicant:
BENDTSEN ELECTRIC
49605 MAGNOLIA DR
MORONGO VALLEY, CA 92256
Owner:
WOODY TWRIDT
78755 LOWE DR
LA QUINTA, CA 92253
Contractor:
BENDTSEN ELECTRIC
49605 MAGNOLIA DR
MORONGO VALLEY, CA 92256
(760)459-9011
Llc. No.: 525981
Date: 11/21/2016
Detail: PANEL REPAIR AND CHANGE OUT 125 AMP MAIN BREAKER, (1) 40 AMP TO POLE BREAKER, REPLACE (1) 2 POLE BREAKER. PER 2013 CALIFORNIA
BUILDING CODE
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
TOTALS:0•
$5.00
W
Bin #
Qty of La Q uhi ta
Buitding, & Safety Division
Permit 78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
11'rojcct Address: �Owncr's Name:'
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:Telephone:
Address: Y,? 6 Jv'r -OWOV—Wroject
Description:
City, ST, Zip: .yl 4
eo 00a /C
Telep hone:
01
1,2r ne I
State LicA
City Lic.
—44�
Arch., Engr., Designer:
� 7.1194
Address:
3,,
City, ST, Zip:
Telephone:
M
Construction Type: Occupancy:
State Lic. 4: •oject
Pr type (circle one): New Add'n Alter Repair. Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:)
APPLICANT: DO NOT
N
Submittal
Reqld
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Clieck Deposit
Truss Cafes.
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
Subcokitactor List
Called Q ontact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
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
SCIT061 Fees,
Total Permit Fees