BELC2014-101278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �'BELC2Olc4y"1012
Property Address:
78760 SANITA R
APN:
604163001
Application Description:
REPLACE ELECTRICAL.
Property Zoning:
Application Valuation:
$1,500.00
Applicant:
BRUDVIK INC
600 EUGENE ROAD
PALM SPRINGS, CA 92264
C&' .0 DVOICE (760) 7.77-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/6/2014
Owner:
ARTASHES.KA, SABYAM
� 78760 SAN ITA° DRIVE
CLT O � A n LA QUINTA, CA 92253
AUG 0 5 20A JUj
0- IN QUINTA
COMMUNITY OEVELOPMEM.OEPARTMENT
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 Professions Code, and
my License is in full force and effect.
License Clasps_: _ License No.: 482623
Dat Con tr .r
OWNER -B ILDER DECLARATION
I hereby affirm under penalty of perjuy that I am exempt from thContractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city orcounty 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
ere 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 contractor(s) licensed pursuant to the Contractors'
State License Law.).
(_) I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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 Addre!
Contractor:
BRUDVIK INC
600 EUGENE ROAD
PALM SPRINGS, CA 92264
(760)320-4429
Llc. No.: 482623
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
I have and will maintain acertificate.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:— Policy Number:
—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, 1 II forthwith
comply with those provisions
WARNING: FAILURE TO SECURE WORKERS"COMPENSATION COVER E IS UNLAWFUL,
AND SHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDS IVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMP(NSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANTACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each persomupon whose behalf this application is made, each person at whose
requestand for'whose benefit work is performed under or pursuant to any permit issued
as a result ofthis.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
followingissuance 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 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 city o enter upon ab -
mentioned`property for
inspection purposes.
Date 9rJ � / Signature (Applicant oM-g—cent) -
FIR
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y- 'fig- �. ':� .-m. g ' s ;� �" u..38�sia'i.yalv)3��'3 4m
DESCRIP,TION, �01,11ACCOUNT ' AMOUNT #�
WINHIM
PAID�DATE
:-
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*.,E' r..w• t. .vtA�T-5w..... .„ ilu^t ; .. ;'4^x:2.: p:
a:.'' a ?v';:47&i-. w,<u a,�3r.:u.. -.. , e'�.'.'3'.•n�o .. rna'.MS
BSAS,SB1473 FEE10f00 030
0u.o
$0.
�00
i�
5 L{
M�uY�UM+T
'AIU
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Yjb"Vt2��rF 9Li
�00KT�0
h 54, sPPY
Total Paid forBUILDING: STANDARDS ADM INISTRATION',BSAc $100 $0.00
a?ts fl� her in - . k i2t� s3J?p1'.., rRwss , y
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IDS�r�FAIDDAT:
4Ser
7UESRP;TIONia4T" _ aACCOUNT
4Tty
` .:. M>OLcN
POWER APPARATUS
101 0000-42403
0
$23 83
r --$0.00
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�ACCOUeNT '„� �
3i"r"Yz .� .e. •e. -4{• fn. .r 4?rrSb,-,sssSA52tt
QT4Y -AMOUNTS ' =i'
r,v r "-,, t
' PAID
£. t},^.�5':'4';
�PAID�DA�IN
�
: *�6kZ:,...t��i
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3:�?A�c
.+R -
POWER APPARATUS PC
..
1010000 42600:
.,i
0 $23F83 ' .
$0.00
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ITS,
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i�•
_101
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Total Paidfor ELECTRICAL $47 66 ; $0.00 .
A`'K?�'sx`!L= ..._'`.,+i s• 4N 2,ca..
' §
P .'.»`�i .�aa ."�
YtF�fan' 1.. `-�...
QTYrn AMOUNT
;��y+."3'"F
PAID
DATE
�. DESCRIPTION
, ACCOUNT
PAID
PERMIT..ISSl1ANCE
101-0000-4240 4
00
,.$0
>,+}CEIPT#+E�
#> .CLTiD,BY
Total Paid for PERIVIIT�ISSUANCE F $90 57 Q.00
'� ��.. _ ,.'�::�. ...-:. ..:. .... �.. . ,.s-.,., ..:. ....... Aas .;.. �... .,.ai. _.u.: _ ......K..-:S! -u?1 .:.c:...: 'Hij[.. P..'1, r,?.➢:SY ..F .-�... . i.(' . _::1 ,..Yl kt_.!Ltu v •tt _. .P � 1,:.+ ...: .....,• ..
Bln.#
QW of .La Quihta
Building 8i Safety Division
P.O. Box 15K'78-495-Calle Tampico
(a.Quinta, CA 92253 - (760) 777-7012
Building Permit ApPlication'and Tracking Sheet
Permit #
Project Address: 78760 Sanita Dr
Owner's Name:. T ( -fj NZ✓ k(l:
A. P. Number.
Address: .
Legal Description:
City, ST, Zip:
Contractor: Brtidvik, Inc.
Telephone: (� °�
a
Address: 600 S. Eugene Rd.
Project Description:
City, ST, Zip: palm Springs, CA, 92264
Electrical Panel Change. Out
Telephone: 760-320-4429
" k '
,�'th>1/G% 10J 4
Stats Lic. # : 482623
City Lic. # 2542
Arch., Lrngr., Designer:
Address:
City., ST, Zip:
Telephone: Construction Type:.. Occupancy:
State Lie. M Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: 'Lenard Rymer Sq. Ft.:#Stories: #Units:
Telephone # of Contact Person: 760-272-4728 Estimated value of Project $1,500
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Retia
Rec'd
TRAQMG
PERMITFEES-
Plan Sets
Plan Check submitted
Item Amount
Structural Calci.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Pcrson
Plan Check Balance_
Title 24 Calci.
Plans picked up
Constraedon
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2'! Review, ready for correctionsrLuue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN lIOUSE:-
''" Review, ready for corrections1issae
Developer Impaet Fee
Planning Approval.
Called Contact Person
A:LP.P.
Pub. Wks. Appr '
Date of permit Issue
Schod) Fees
Total Permit Fees
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