ELEC (07-2884)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
07-00002884
53027 MERIWETHER WY
767-200-99,8-80 -.330761-
ELECTRICAL
LOW DENSITY RESIDENTIAL'
2500
Architect or
LICENSED CON CTOR'S D
I hereby affirm under penalty of perju that I am licen u er provisio
Section 7000) of Division 3 of the Busi Pr s' Code, my
Licen - lads: C10 C20 C3 LiCen. o.:
(/ r
Da Contractor:
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
g(commencing with
n full force and effect.
"I — OWNER -BUILDER DECLARATION.
1 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 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.).
(_ 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
EAST OF,MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:.
BRUDVIK, INC.
600 EUGENE ROAD'
-
PALM SPRINGS, CA 92264
(760)320-4429 .
Lic. No.: 482623
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/01/07'
=--------------------------------------------
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
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 INS CO OF WEST y Number WSD2158
I certify that, in the perfo ce of the work for which this permit is issue shall not employ any
person in any m er so as to become ubject to the wor rs' compensati n laws of California,
and agree the , ' the wor compensation ovisibns of Section -
3700 of the Labor Code, 1 s compl i rowsai
Da[e:4 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 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 ofissuan4such , or cessati ork for 180 days will subjectpermit to cancellation.
I certify that I have read this application and statee i rmat' is ct. I ree to comply with allcity and county ordinances and state laws relating hereby autho 'ze representatives
of this cpyntytor/N/cr upon the above-mentioned i rpDate:/('/_V/Signature (Applicant or Agen
s
Application Number . . . . . 07-00002884
Permit . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee 90.00 Plan Check Fee
22.50
Issue Date . . . . Valuation
0
Expiration Date 4/29/08
Qty Unit Charge Per
Extension
BASE FEE ",
15.00
1.00 75.0000 to ELEC.SVC'..>600V -0R >1000A
----------------
75.00
----------------------=--------------------------
Special Notes and Comments. -
ELECTRICAL SERVICE #6 NEW 1600 AMP,
277/480V 3PH 4W
2001 CBC, 2004 CEC CODES,'. -
***THIS PERMIT REFLECTS THE,RELOCATION .
OF THE ELECTRICAL SERVICE FROM PREVIOUS.
PERMIT ## 06-1050.***
Fee summary. Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 90.00 .00 .00
90..00
Plan Check Total 22.50 .00 .00
22.50
Grand Total. 112.50 .00 .00
112.50
I
LQPERMIT