09-0548 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
-09-000.00548
Property Address:
54560 AVENIDA RUBIO
APN:
774-272-003-22 -000000=
Application description:
ELECTRICAL
Property Zoning:
COVE RESIDENTIAL
Arrliratinn ;,2!:19tion:
915
Applicant:
T4ht 4 4& Q"
Architect or Engineer:
1 1p
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FLORES ABBY
54560 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor: D
COVE ELECTRIC, INC.
77824 WILDCAT DRIVE J
PALM DESERT, CA 922
(760)360-0036
Lic. No.: 397002 I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
W U
JUN 02 20109
G1TY ►�rQU;NTA
C,.,,,...---
Date: 6/01/09
-------------------------------------------------------------------------------------------------
. LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
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 Business and Professionals 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 License No.: 397002
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
(/
Dater 7 ontractor:
�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 workerscompensation
OWNER -BUILDER DECLARATION
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 ZENITH INS CO Policy Number Z06855503
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 should become 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
- 3700 of the Labor Code, I shall forthwith 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: Applic
( ) 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 O SECURE WORKERS' COMPENSATION_C.00i AGE 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 15100,0001. 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. '
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.).
APPLICANT ACKNOWLEDGEMENT
(_ 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,
1 _ 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 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:
LQPERMrT
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 c ty to enter upon the above-mentioned property for inspection purposes.
Pd`e: AS' cure (Applicant or Agent):
Application Number . . . . . 09-00000548 ..
Permit . . . ELEC-SERVICE CHANGE
Additional desc .
Permit Fee . . . . 33.50 Plan Check Fee
.00
Issue Date . . . . Valuation. . . .
. 0
Expiration Date 11/28/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 13A FTFC' wr -,_600V/-;-200A
18.50
7 ---------------------------------------------------------------
Special Notes and Comments
REMOVE & REPLACE LUG & SOCKET FOR METER.
BURNED FROM LOOSE CONNECTON ON LINE SIDE
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
..Due
-----------------
Permit Fee Total 33.50 .00 .00
33.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 34.50 .00 .00
34.50
LQPERMIT
Bin #
City of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # (
q, 7
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone
Address:
Project Description:
City, ST, Zip:
Telephone:
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el
State Lic. # :
City Lic. #;
,
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
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Construction Type: Occupancy:
Project type (circle one): New Add'nAlter Repair Demo
State Lic. #
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Estimated Value of Project,-670
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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
Title 24 Calcs.
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:-
Repiew,.ready for correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees