ELEC (13-1149)53540 Madison St
13-1149
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-701.1
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT' INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/11/13
Application Number. 13-00001149 Owner:,„
Property Address_: 53540 MADISON ST EAST OF MADISON LLC
APN: 767-890-.015- - - PO BOX 1482
Application description: ELECTRICAL LA QUINTA, CA 92247
Property Zoning: GOLF COURSE
Application valuation: 0
Contractor: D
Applicant: Architect or EnDBCA INC
P.O. BOX 1482
g7
LA QUINTA, CA 92247q (760) 393-5271 vi:l 2013
Lic. No.: 915336
CITY OF LA QUIN
FINANCF n;zb
LICENSE CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 a Ii ensed er provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an r fessio als , and my License is in full force and effect.
License Class: B License o.: 915336
,'Pate: ' Contractor:
NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I atempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Pr essions 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).:
1 _ 1 1, 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 1, 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 ._
Owner:
Date:
' 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:
T- ..••—l- enaerss+uuress:` - -- -- - -- -- - - -. - - -- -
LQPMIIT
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 TRAVELERS Policy Number YJUB282D7797-12
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 become subject to the workers' compensation laws of California,
and agree that, if I should ome ub to the workers' compensation provisions of Section
37700 of the Labor Code, I all fo thwith c ply with those provisions.
Date: !T, .11 ../ / Appli
fir'
WARNING: FAILURE TO SECURE WORKE 'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABORAI'
CODE, I EREST, 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.
certify that I have read this application and state that the abov i orma o ' correct. I agree to comply with all
city and county ordinances and state laws relating to building co uctio , and eby authorize representatives
of this county to enter upon the above-mentioned property for in c ' :pose
Date: A- 1.3 signature(Applicant or
LQPERMIT
Application Number .
. . . . 13-00001149
Permit . . .
ELECTRICAL 2013
Additional"desc .
Permit Fee . .
23.83 Plan Check Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date
3/10/14
Qty Unit Charge
Per
Extension
1.00 23.8300
EA ELEC'SERVICES
23.83
Special Notes and Comments
ELECTRICAL - TO METER
BOX FOR MEDIAN
LANDSCAPE IRRIGATION.
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
RECEIVED ,
Bin #
City of La Quint.a SEP 06 201
Building 8r Safety Division
P.O. Box 1504 78-495 Calle Tampico CIN OF LR QUI T
La Quinta, CA 92253 = (760) 777-7012 COMMUNITY DEVELO N
Building Permit Application and Tracking Sheet
Permit ti'
/37 1l -1
Prcj6ctAddress:. S ✓ o110'll tor.,
Owner's Name: er-- .
A. P. Number:
Address:
Legal Description:
City, ST, Zip: CIP
Contractor:
Tele hone
Address: !f)
Project Description:
- —
City, ST, Zip:
Telephone:
State Lk. #: City Lie. #;
Arch., E'ngr., Designer:
Address: 161 , !
City., SZ', Zip:
Telephone: 7 rJ' 8
State Li!'.. #:
';; ;• F;.- .;;;; '`}
F Qy ,?-7 y yy `
J
Cotuwction Type: /(% upancy:
Project type (circle one)• ew Add'n Alter Repair Demo
%
Name o:FContact Pelson: V6 1 AW165! /Q
Sq. Ft.: #Stories:
# Units:
Telephone # of Contact Person: G' 7l0
Estimated Value of Projecosfv - _
APPLICANT: DO NOT WRITE BELOW THIS LIN
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubntitted
Mechanical
Grading plan
2"d Review, ready for correctionsrassue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
G'mnt Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plan's resubmitted
Grading
W HOUSE:-
7rd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
ENT