08-0535 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 92253
Application Number:X05
0-00005
Property Address:
52150. AVENIDA RAMIREZ
APN:
773-222-008-15 -000000-
Application description:
ELECTRICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1800 -
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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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, C20 C3 License No.: 482623
e:V7/, ontractor: >yOl J/
OWNER -BUILDER DECLARATION
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'IChapter 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 provingthat he or she did not build or
improve for the purpose of sale.).
(_ I 1, 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.I.
Lender's Name:
Lender's Address:
LQPERMIT .
Owner:
BURRES WALTON
52150 AVENIDA
LA QUINTA, CA
VOICE (760) 777-7012
FAX (760) 777-7011
I CTIONS (760) 777-7153
v (/ Date. 3/31/08
L q�3j?0
RAMI C/ Op
92253
Contractor:
BRUDVIK, INC.
600 EUGENE 'ROAD
PALM SPRINGS, CA 92264
(760)320-4429
Lic. No.: 482623
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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. -
W� 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 Policy Number 'WSD215878103
_ 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 provisions.
pJ%oY 'Cant:
WARNING: FAIL RE 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 orpursuant 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 omissionrelatedto 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 co to enter upon the above-mentioned property for inspection purposes.
D Jl 6 1 /Salue (Applicant or Agent): KJD�
Application Number . . . . 08-000.00535
Permit . . . . . . ELEC-SERVICE
CHANGE
Additional desc .
Permit Fee . . . . 33.50
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 9/27/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00. .
• 1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
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'" Special Notes and Comments
-----------------
REPLACE 125 AMP ELECTRICAL PANEL
Fee summary Charged
Paid Credited
Due
Permit Fee Total 33:50
.00 ..00
33.50
Plan Check Total .00
.00 .00
..00
` Grand Total 33.50
.00 .00.
33.50.
LQPEP-MIT .
Bin #
CKY of La. Quinta
Building.& Safety Division
Permit .# P.D. Box 1-504, 78-495 Calle Tampico,
U Quinta, CA 92253; - (760) 777-7012
Building Permit Application and. Tracking Sheet
Project Address:' 5;H 5 b .A vi? . `fir.:: r tz Owner's Name: i40,s �cN0CS
A. P. Number: Address: — — -
SZIS1i 14 L
Legal Description: City, ST, Zip:
\ LA 4w.,, eA 42zs�.
Contractor: Telephone:.
Address: Project Description:
City; ST, Zip:�A �M $ S Ce3 2211
Aa 12-5 14 6 t fir;ew
.
Telephone: 2j _ Ll y 2
State Lic. # Z (y Z City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: Construction Type: Occu anc :
^ P Y
State Lic. #:
Project type,(circle one): New Ad
d'n Alter Repair Demo
Name of Contact Person: Sq. Ft : #Stories: .
# Units:
Telephone # of Contact Person: O , 13 1 Estimated Value of Project:. 1. tai,
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan._
Grading, plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
eq'd
Recd'
'TRACKING
Plan Check submitted
PERMIT FEES
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2n° Review; ready for correctionsrissue
Electrical
Called Contact Person
,Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Review,ready for corrections/issue
Grading
Developer Impact Fee
Called Contact Person
A.LP.P.
Date of permit issue
Permit Fees
n