13-0614 (ELEC)_1,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000614
Property Address: 57620 BLACK
APN: 762 -380 -028 -
Application description: ELECTRICAL
Property Zoning: LOW DENSITY
Application valuation: 717
Applicant:
DIAMOND
RESIDENTIAL
Architect or I
1"J
Tit�t
�W
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------
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:- CIO C20 C3 /- License No.: 482623
3 1ontr`acy F �ofl<:: OWN -BUILDER DECLARATIONI hereby affirm under penaltat OWN
t from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business an s 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 _ 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. , 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:
LQPEPMIT
VOICE (760) 777-7012
FAX (760).777-7011
INSPECTIONS (760) 777-7153
Date: 5/15/13
Owner:
GARY SODIKOFF
57620B BLACK DIAMOND
LA QUINTA, CA 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
mor 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 andpolicynumber are:
Carrier EVEREST NTL INS Policy Number 7600008989131
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 beco subject to the workers' compensation provisions of Section
3700 of tthhe'Labor Code, I shall f hwith comply with those provisions.
WARNING: FAILURE TOS RE WO E ' COMPEN TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER CRIMINAL EN TIES AND IVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN A TION TO COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR C ST, AND AT ORNEY'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 will subject
permit to cancellation.
I certify that I have read this application and state that the above i rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons tion, and hereby authorize representatives
of this,county to enter upon the above-mentiong9-praper(y'for inspe 1 purposes.
' / 3Signature (Applicant or
Application Number . . . . . 13-00000614
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 34.25 Plan Check Fee
8.56
Issue Date . . . . Valuation . .
. . 0
Expiration Date 11/11/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
1.00 18.5000 EA ELEC SVC <=600V/<=200A
18.50
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Special Notes and Comments
INSTALL (1)ONE 240V, 40 AMP CIRCUIT FOR
ELECTRICAL CAR CHARGER INSIDE GARAGE.
2010 CALIFORNIA BUILDING CODES.
----------------------=----------------------------=------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
=---------
Due .
----------
-------------------------------------
Permit Fee Total 34.25 .00 .00
34.25
Plan Check Total 8.56 .00 .00
8.56
Other Fee Total 1.00 .00 .00
1.00
Grand Total 43.81 .00 .00
43.81
LQPERMIT
Bin. #City
of b Quinta
Building a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building PermitAAp !►cation and Tracking Sheet
Pe it I
Project Address: S� [oZG 3c.Ae� Ck � ^ �
Ownees Name: .
A. P. Number.
Address: �coZG C) 1 qtr �eyv.�
Legal Description:
Contractor. /� //2 vTj� 1 /� �L-r-�1K�
City, ST, ZipL,,-, G2 CA .
Telephone: _--
Address:(p<r_,�� v.�, . _
Project Description: ,=�J
City, ST, Zip:
C
'telephone. 32e -411-�t E
n
�L
StateLic.#: Z�Z3 ZCL..
Archy Engr., Designer.
Address:
City, ST. Zip:
Telephone:
Construction Type: LLQ =c,� Pancy:
Project type (circle one): New Add'ri Alter Repair Demo
Sq. Ft: Z'� �i #Stories: # Unix
State Lic. #: "
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project ( 't -
APPLICANT: DO NOT WIrM BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACHING PERMU FEES
Plan Sets
Pian Check submittedItem Amount
Structural Calm
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cates.
Called Contact Person Plan Cheek Balance
Title 24 Cates.
Plans picked up Constrncdon
Flood plain plan
Plans resubmitted.. Mechanical
Grading plan
2'f Review, ready for correctionemue Electrical
Subcoutactor List
Called Contact Person Plumblag
Grant Deed
Plans picked up S hLL
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''4 Review; ready for corrections/issue Developer Impact Fee
Planning Approval.
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees '
Total Permit Fees
,Ccacbella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/ND. AMOUNT:
nATF.,
RF.CF.TPT-
CHECK N.
fMTIAIA-
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name:
Date
October 13, 2004
Owner's Name: Chock & Sally Silva
Phone
Project Address: 57-620 Black Diamond La Quinta, CA
Room addition
Project Descri tion:
APN 762-380-028
Tract
Lots
Type of Development: I Residential XXX I Commercial I Industrial
Total Square Feet of Building Are 1150 sq. ft.
Certification of Applicant/Owners: The person signing certifies that t e abo ormation is correct and makes this statement
under penalty of perjury and further represents that he/she is au orris sign on b half of the owner/developer.
Date October 13, 2004 Signature: ��--
***********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 ' Requirement
Note:
Number of Sq.Ft.150
Amount per Sq-Ft.
0
Amount Collected 0
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School