13-1042 (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:
13-00001042
57757 SANTO THOMAS
762-240-014-9 -34243 -
ELECTRICAL
RL AG/EQ OVERLAY
1000
I hereby affirm under penalty of pE
Section 7000) of Division 3 of the
License (ilassl B
Oate: « , Contractor:
tis/'
Architect or Engineer:
V\�
4 4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-----------------------------------
LICENSED CONTRACTOR'S DECLARATION
ry thatI am licensed under provisions of Chapter 9 (commencing with
siness and Professionals Code, and my License is in full force and effect.
L' ense 69219
OWNE ILDER DECLARATION
I hereby affirm under penalty of perjury that I am exer6pt from the Contractor's a License Law for the
-following reason (Sec. 7031.5, Business an Professio Code: Any cit ounty that requires a permit to
construct, alter, improve, demolish, or repai any structure, p i s issuance, also requires the applicant for the
permit to file a signed statement that he or he is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing wi 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 (5500).:
(_ 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.).
(_) 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 contractors) 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:
LQPERDIIT
Owner:
ALTA VERDE CONSTRUCTION LL.
71905 HIGHWAY 111, STE `Q` --
RANCHO MIRAGE, CA 922701
(760)077-6111 II II
Contractor: ' -
ALTA VERDE BUILDERS, INT¢
71905 HIGHWAY 111, SUITE G
RANCHO MIRAGE, CA 92270
(760)776-1111
Lic. No.: 969219
VOICE (760) 777-7012
'f FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/19/13
LJ"t�
12 113
CITY OF LA QUINTA
-----------------------------------------------
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
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 workers' compensation
insurance carrier policy number are:
Carrier STATE FUND Policy Number 9006140
_ I certify that, in the pe rmance of the work for which armit is issued, I shall not employ any
person in any mann so as to become subject to the workers pensation laws of California,
and agree that, if 1 uld become subject to the workers' compens n provisions of Section
1r 3700 of the Labor , I shall forthwith comply r
Date: l Applicant:,
WARNING: FAILURE TO SECURE WORT RS' COMPENSATI N COVERAGE IS UNLAWFU AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CI IL FINES UP TO ONE HUN ED THOUSAND
DOLLARS ($100,000). IN ADDITION T THE COST OF CO NSATION, DAM AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORN
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 ap"Co
es null and void if work is not commenced
within 180 days from date of issuancit,. or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tnformation is correct f-3qree to comply with all
city an .cou y ordinances and state laws relating ttruction, and here auho?I representatives
of this ount t enter upon the above-mentioned ppection purposesDate: `JA
Signature (Applicant or Agent)
i
LQPERMIT
Application Number
13-00001042
'Permit ELECTRICAL
2013
Additional desc .
Permit Fee . . . . 23.83.
Plan'Check Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 2/15/14
Qty Unit Charge Per
Extension
1.00 23.8300 EA ELEC
SERVICES
23.83
Special Notes and Comments
ELECTRICAL-- (1) TEMPORARY POWER
POLE.
•2010 CALIFORNIA BUILDING CODES.
-----------------------------------------------------------------------------
----------------------------
Other Fees . . . . ...
Other
----------------------
BLDG STDS ADMIN (SB1413)
1.00
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
.-00 .00
.00.
Other Fee Total '103.49
.00 .00
'103.49.
Grand Total 127.32
.00 .00
127.32 .
i
LQPERMIT
1 � � Rk
AUG 16 201"
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
ED
BIn.#
City. of La Quintd
Building a Safety Division
P.Q. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777 7012
Building Permit Application and Tracking Sheet
Permit #
I�
Project Address: SolZSi SOV410 T M Owner's Name:.
�/ /� r
A. P. Number. . ( L.. 1-40 Q 1 Address:
Legal Description: City, ST, Zip: �.". C4%. 2.7. -JO
Contractor. f2 Telephoneel(40
Address: t C105Project Description:
City, ST, Zip: Z Z
Telephone -717#— t 11A � t. � s T P JnVV C9, %L
State Lic. #:01 2 City Lia #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: Construction Type:. Occupancy:
h
State Lic. #: k Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person .�.`� �b�,} Sq. Ft; # Stories: # Units:
Telephone # of Contact Person ( Estimated Value of Project' D t7
n'
175 C� ��Ve'✓�'e-•�"ti
LI NT: DO NOT WWTE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Chcck Deposit. .
Truss Calcs.
Called Contact Person
Plan Cheek Balance.
Title 24 Calci.
Plana picked up
Construction
Flood plain plan
Plans resubmitted..
Mechatilcal
Giading plan
Review, ready for correctioustissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Ad.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
AUG 16 201"
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
ED