11-1045 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X11-000 01 45
Property Address:
48490 SAN VICENTE ST
APN:
646-140-030- -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
- 1850
T-iht 4'4 Qamk
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
LICENSED CONTRAC OR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed and provisions of Chapter 9 (commencing with
Section 70 0) of Division 3 of the Business and Pr essional ode, and my License is in full force and effect.
License ss: 0 cense No.: 536093
ate: ntractor:
OW R -BUILDER DECLARATION
I here y 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).:
(_) 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, 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 (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:__
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/28/11
Owner:
HARDY JAMES F
48490 SAN VICENTE STREET
LA QUINTA, CA 92253
p o
Contractor: p 1
MIRAGE ELECTRIC
19400 FORD AVENUE
DESERT HOT SPRINGS, CA 22CITYOFU►(91151NTA
(760) 408-3125 IN WCE"PT..__^ �.
Lic. No.: 536093
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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.
_ 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 WET Policy Number EXEMPT
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 su ect to the workers' compensation laws of California,
and agree that, if I should become subje to the workers' compensation provisions of Section
of the Labor Code, I sh forthw' comply with those provisions.
ate: plicant:
WARN G: ALURE TO SECURE WORKERS C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN IES 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 of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certifythat have read this application and state that the above information is c ct. I agree to comply with all
city and co ty ordinances and state laws relating to building construction nd reby authorize representatives
of ty to a tier upo a above-mentioned property fo 'nspecti rp es. .
ate: 1 nature (Applicant or Agent):
Application Number 11-00001045
Permit ELEC-SERVICE CHANGE
Additional desc .
Permit Fee 33.50 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date 3/26/12
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
INSTALL NEW 200 AMP ELECTRICAL SERVICE.
2010 CODES
-
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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
stn.#
cis/ Of La Quints
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777-7012
Buildi g Permit Application and Tracking Sheet
Permit #
0
Project Address:wner's Name:.
A P. Number. Address: ?0 C / 'rTki:'
Legal Description: City, ST, Zip: ' It—
Contractor w ^-C-I/�
Address: :► (� ProjectDesc prion:
City, ST, Zipt z,
2SZ (fit_ C C O U. T a 6
Telephone2,-3 8 3/ �.
i z cake( �.L 1 U L
State Lic. # :Z7O 3 City Lic. #; �C—
Archy Engr., Designer.
Address:
City., ST. Zip:
Telephone: a ' ' Construction Type: , Occupancy:
State Lie. #: '" Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project: (� U
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
'Rec'd
TRACKNG PERMPTFEES'
Plan Sets
Plan Check submitted.Item
Amount
Structural Calea
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cale"
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2id Review, ready for correetionstiissue
Electrical
Subeontactor List
Called Contact Person
Ylu. .
Grant Deed
Plans picked up
S.M.L
H-O-A- Approval
Plans resubmitted
Grading
AV HOUSE:-
''a Review; ready for correetionvluue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees '
Total Permit Fees