ELEC (06-1045)a`q
P.O.-BOX 1504
i
(760) 320-4429
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
t6-OOOOT0451
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Property Address:
52302—MERIWETHER WY
APN:
767 -200 -998 -G -330762 -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL •
Application valuation:.
2500
• 4'Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer
0"
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
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Contractor:
BRUDVIK, INC.
600 EUGENE ROAD
PALM SPRINGS, CA -92264
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/07/06
f
Date:
Owner:
CONSTRUCTION LENDING AGENCY -
I hereby affirm underpenalty 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:
LQPEWMIT
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 inforr1t ation is correct. I agree to comply with all
city and county ordinances and state laws relating to uildin constr J ion, and hereby authorize representatives
of this county to nter upon the above-mentioned pro rt or ction purposes.
\Date: Signature (Applicant or Agent)
(760) 320-4429
Lic. No.: 482623
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 Businey and Pr f ssionals 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 C2.0 C3 License No.: 482623
- for by Section 37,00 of the Labor Code, for the performance ofthe work for which this permit is
-
•-
issued.
\at Contract •
_ 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 DECG4RATION
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 INS CO OF WEST Policy Number WSD21878101
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance 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 s u beco 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
of the Labor C de I fo with 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).:
ate: pplicant: - -
�yLO
1 _ 1 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 SECU E WO KERS' COMPENSATION OVERAGE 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 is 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. ,
dne 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
1 = 1 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 _ 1 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
Date:
Owner:
CONSTRUCTION LENDING AGENCY -
I hereby affirm underpenalty 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:
LQPEWMIT
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 inforr1t ation is correct. I agree to comply with all
city and county ordinances and state laws relating to uildin constr J ion, and hereby authorize representatives
of this county to nter upon the above-mentioned pro rt or ction purposes.
\Date: Signature (Applicant or Agent)
Bin #E:-302City
of La Ouin'ta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
00,1045
Project Address:'Y►n ` -I w C, W
Owner's Name: t`
A. P. Number: '1&7-. ZO200' qQ�p� • ' 3 l �p 2
Address:
Legal Description: 3 D .
Contractor: T010V fC.
City, ST, Zip: l
Telephone: 3 -So7Z
Address: LIMjam, e J ,
City, ST, Zip:. PA 50 NI.-- CISe4f
Project Description:
rvteL GI
Telephone:
State Lic. # : Z 3
City Lic. #:
Arch., Engr., Designer:
Address:A.
'o.� D
City, ST, Zip:
� 113 HT1
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 Projec . Z SO u .
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy. Calcs.
Plans picked up
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading.plan
2" Review, ready for correctionsfissue
3
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"d 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
X� J OR'RM 00,1� U2. X50