ELEC (13-1314)58813 Marbella
13-1314
4 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: 10/15/13
Application Number: 13-00001314 Owner:
Property Address: 58813 MARBELLA CORAL OPTION I
APN: 764-200-068- - - 81570 CARBONERAS a
Application description: ELECTRICAL LA QUINTA, CA 92253 D
Property Zoning: GOLF COURSE
Application valuation: 1000 C
Contractor:
Applicant: Architect or Engineer: TD DESERT DEVELOPMENT LP CITY of LAQVINTA
P.O. BOX 1716 Cl; (of:
DEPT.
LA QUINTA, CA 92247
(760)77
Lic. No..:: 762 762987
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, and my License is in full force and effect.
License Class:
B License No.: 762987
Date: d",0 2Contractor:
OWNER -BUILDER DECLARATION
i
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).:
(_ 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
propertywho 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:
LQPERMIT
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
/ssued.
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 CA REST MUTUAL Policy Number CRO1134517
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 isrrowsions.
Date: Applicant:1 E11 G_si—
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 ($100,0001. 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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
/ i
Date: Signature (Applicant or Agent):
Application Number . . . . . 13-00001314
Permit ELECTRICAL 2013
Additional desc .
Permit Fee . . . . 23.83 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/13/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC SERVICES
23.83
---------------------------------------7------------------------------------
Special Notes and Comments
ELECTRICAL - INSTALL 200 AMP 277/480
TEMP POWER PEDESTAL FOR CLUBHOUSE
CONSTRUCTION (PER APPROVED SITE PLAN).
2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, ELECTRICAL
11.92
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 103.49 .00 .00
103.49
Grand Total 127.32 .00 .00
127.32
LQPERMIT
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
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City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Caile Tampico
La Quinta, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
Permit #
1-171
Project Address:
Owner's Name:
A. P. Number: ? (� Zoo ap Yo
Address:
Legal Description: 1 r o c4-
City, ST, Zip: Lo, C. < 2 L r 3
Contract r: �� s%C++ .� L
Telephone:? Go 7 7 7 / o o /
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Address:8 �^ ,J Ca a yew
Project Description:
City, ST, Zip: Cl 47 L Z S
}00 /. j *% 2%-7V$c
Telephone: -70
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State Lie. # : -7 (pZ g'$ 7
ity Lie. #t 9ry
Arch., Engr., Designer: 1 (�
Address:
City, ST, Zip:
yy
Telephone: �;";,..,;:.s.,•4
State Lie. #:t
Name of Contact Person: N p (4 ,\ G (k >
Construction Type: Occupancy:
Add'n Alter Reairoectacrcle one Demo
Sq. Ft.: # Stories: # Units:
Telephone #,of Contact Person: p 1-11 1 '77
Estimated Value of Project: 1. oe o
APPLICANT: DO NOT WRITE BELOW THIS LINE
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I Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Pian Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionstIssue
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
° �4
s DEMAND /' -;CHECK REQUEST
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Return check to requestor Mail check
Name / Title of person requesting check
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DeRajtment individual is associated with:
Check payable to:
(Name) (Vendor No.)
(Address)
Lk&WA,
Check description and invoice number:
Amount: $ 4,V7
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Account Number: O �oV 220,
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Project Number: I 4W-13
14-
Signature:
Department ea
'APPROVED.,FOR PAYMENT,
`a
. k' (Finance Department We'Only)
BY:
BY:
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