13-1294 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
004-t
13-00001294
51675 AVENIDA RUBIO
7737121-014-3 -000000-
ELECTRICAL
COVE RESIDENTIAL
1000
c&ht 4
BUILDING & SAFETY DEPARTMEN
BUILDING PERMIT 'L -
_:P
Architect or Engineer:
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: C10 License.No.: 748171
Date V/13 Contractor. -`
OWNER -BUILDER DECLARATION
hereby affirm under penalty of perjur t 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 _ 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.).
I—) I am exempt under Sec. , BAP.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
Owner:
BOYD TIMOTHY
51-675 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
HEGGE ELECTRICAL CONTRCTRS
83852 AVENUE 45
INDIO, CA 92201
.(760)775-4855
Lic. No.: 748.171
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: '10/10/13
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.
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 workerscompensation
insurance carrier and policy number are:
Carrier BENCHMARK INS Policy Number CST5002276
1 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.
Date -k L Applicant:
�r
WARNING: FAILURE TO SECURE ORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI INAL LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIVOWTO 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 willsubject
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 coin�_�''////°�%�enter upon the above-mentioned property for inspection purposes.
Dat( DaSignature (Applicant or Agent): _
Application Number . . . 13-00001294
Permit . . . .ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 23.83
Plan Check Fee
.00
Issue.Date . . . .
Valuation
0
Expiration Date 4/08/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC SERVICES
23.83
--------------------------------------------------
Special Notes and Comments
--------------------------
ELECTRICAL - SERVICE PANEL CHANGE OUT.
2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . 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
.0.0 .00
.00
Other Fee Total 102.49
.00 .00
102.49
Grand Total 126.32
.00 .00
126.32
LQPERMIT
Bin #
Qty of ra Q uin to
Buuilding 8T SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address:S — 7 '
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: C4, a C
Contractor:
C,Ra;:<>4»
Telephone:
Address: C S
Project Description:
City, ST, Zip: 2 O (i4 G��Cr
` 4' M 4
Tele hone:?(0
MEMO=
State Lic. # : Wuo%7 l
City Lic. #•: gl g
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Arch., Engr., Designer:
T�
Address:�,y
City., ST, Zip:
Telephone: ::.... : :< •;::::;<: :': w ;; .:'•
State Lic. #
Name of Contact Person:
Construction Type: Occupancy:
Project a circle one): New . A
J type � ) dd'n Alter Repair Demo
Sq. Ft.:#Stories:
#Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
j
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
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