10-0290 (ELEC)Ti "IP.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICOFAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING &-SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT '
Date: 4/07/10
Application Number: 10•'-`0:0:00012:90 Owner:
Property Address: 50
77
Property PALOMA BRADDOCK WILLIAM R/GABRIELE
APN: 770-096--004- - - 50735 CALLE PALOMA
Application description: ELECTRICAL. LA QUINTA, . CA 92253
Property Zoning: LOW. DENSITY RESIDENTIAL
Application. valuation: 2500 r v U r
Contractor: ® .
Applicant: Architect or Engineer: RANGEL,- INC.
78451.EMERELD CR ST -D
} BERMUDA.DUNES, C 20
(760:):360-7377 �'1i7j4"4 �U.,
Li C.. No.: 753548
Tit';. .. .. .. •
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION ,
hereby affirm.underpenalty of; perjury. that. I..am I sed under'preovisions of,Chapter 9. (commencing with - I hereby affirm under penalty of perjury one of. the following declarations
Section 7000) of Division 3o'f:the Business.agd ro s "6o Is'Code, and my License is imfull'force and effect. _ I'have and will maintain a certificate of consent to. self-insure.forworkers' compensation, -as provided
Licens Class:, C10 Lice N "753548' . forby'Section 3700'6f the Labor Code;•for the performance of the work for which th_is•permit is
issued.
Date:�0.. - ttractor- j - 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
ILD
' OWNER-BUE DECLARATION insurance carrier and policy number are.
hereby affirm under.penalty of perjury that I am exempt from therContractor's'State License Law for the r Carrier SOUTHERN INS Policy Number WS106168002
following reason (Sec. 7031.5,, Business. and Professions Code-- Any city or county that requires a permit to _ I certify that, in the performa/the�.foFw this; permit is issued, 1 shall not employ any
construct, alter, improve, demolish,or repair any structure, priorto its issuance, also requires the applicant for the person in any manner sobje o" e'workers' compensation lawsof-California,
.: permrt`to file a signed statement'that:he or she isiicensedpursuantto the provisions of. the Contractor's State - '.'and agree that; if I should th orkers' compensation provisions of Section
License�Law-(Chapterr9i(commencing with Section. 7000) of Division 1of the Business and: Professions Codelor - 700 of the Labor Code,.ply with those provisions.
that heor she is exempt therefrom and thebasis:for the alleged exemption. Any violation -of Section 703,i.5 by .,
any applicant for a permit subjects the applicant to.a cMI penalty of not more than five hundred -dollars ($500).:' ate: �� Ap ' '
( -) 1, as owner of the property;, or my, employees with'wages'as theirsole.compensation; will ado the work, and
•.the structure is not intended oi'offered for sale (Sec. 7044'; Business :and Professions Code:' The WARNING :FAIL RE TO'SECURE WORKERS' -C NIPENSATION COVERAGE ISUNLAWFUL, AND SHALL -
•.Contractors' State License Law does not apply to -an owner of property
-who builds -or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAUPENAL IES AND CIVILFINES UP TO ONE HUNDRED THOUSAND
and who does -the work himself -or herself through his,or her own employees, provided that the DOLLARS (5100;000). -IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended'or offered.forrsale! .If; however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
one year of completion, the owner -builder will have the burden of proving that heorshe did not build or
improve for the purpose of sale.).- APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property; am exclusively contracting with licensed contractors to construct the project (Sec. •IMPORTANT Application is hereby made to the Director of: Building and Safety for a permit subject to the
7044, Business and -Professions Code: (The Contractors' State License Law does not apply to an owner of conditions and restrictions set. forth on this application.
property who,builds or improves thereon, and who contracts for the projects with a.contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).. whose benefit work is•performed'.under or. pursuant to any permit issued as *a result of this application,
(_ 1 1 am exempt under Sec. , B.&P.C. for this reason 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 oi.omission, related to the work being
performed under or followingissuance ofthispermit.
Date: Owner: - 2. Any permit issued as a result of this application becomes null and void if work isnot commenced
within 180 days from date of issuance of such permit, or cessation f work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above informati i correct. ree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to buildingLconstructi d hereb thorize representatives
of this coun to enter upon the above-mentioned property for inspecti rposes
Lender's Name:
te: Sig re (Applicant or Agent):
Lender's Address: r,
LQPERMIT . -
LQPERMIT
Application Number 10-00000290
Permit . . . ELEC-SERVICE CHANGE
Additional desc .
Permit Fee 52.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
0
Expiration Date .. 10/04/10
' Qty Unit Charge Per
Extension
BASE FEE
15.00
1-00 37.5000 EA ELEC.SVC <=600V/>200A/<=10.00A
37.50
Special Notes and Comments;"
..t _ §
REPhACE -! RECESSED` 2'0'0 AMP'' PANEL` WITH` 1
L,
400 `.`AMP .METER MAIN ,- RECESSED. 2007..'.
CODES.
_--------------------- - - - - --------- -- - --- -. -
Other Fees BLDG. STDS ADMIN (SB1473)
-
1:00 -
Fee-summary Charged Paid Credited
Due
--- ---- --
Permit Feer Total -52.50 ------ 0.0 0.0
52.50. s
Plan: `Check: Total : 00 . 00 0'0
00
.-
-Othe`r;.Fee .Tdtal 1.00. 00 00
1.00
Grarid`Total 53:50 00 00
53.50
LQPERMIT
.. . , ..t r.. 3'4 t 7 ..
Bin #
.0 ty ofta Quinta
Building MSafetyDivision
Permit # -�yh
P.O. Box,1504, 78-49S�11e Tampico
►.a Quints, CA 92253 (760) 777-7012
Bgitgipi Permit;'Apphcation4hd Trackin# Shee_.
Y-.i"^f-.. n t _.
Project Address:55-735 _
Qwner's Name '
A. P. Number:
..'°Address:
Legal Description:
City, ST, Zip: • lti+i4
Contractor: A f
V G /v C-
::;>• <
'Telephone: 4 `.sN>
p
..a:<�
Address: 7 �� p
�� `' � S �K Project Description:
, � �C �C'
City, ST, Zip: % VV� �
00,SL
3 0(%
/1> •>q
Telephon :76US—�7.� S� ° : , . r A4411V__EG QS59i,2
State Lic. # : City Lic: #; ' "
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:`
;
Comstructio T}+pe: 00cupan-
-----
State Lic., #:
Project type (c. one) : New Add'n . Alter Repair Demo
Name of Contact Pearson:
Sq, FL: #Stories'. #Units:
Telephone # of Contact Person:
Estimated Value.of Project: ;2J (JU
,APPLICANT:
DO'NOT WRITE BELQW THIS;;LINE r
# Submittal Req'd Recd
„TRACKING,. PERMIT FEES
Plan Sets
Plan Check submitted '
Item
Amount
Structural Cala. ,
4�eviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
'
,Plan Cheek Balance
_
Title 24 Cala.
Plans picked up
' Construction '
Flood plain plan
Plans resubmitted '
Mechanical
Grading plan
2'! Review, ready for corrcctionwissue'
Electrical
Subcontactor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
S.M.L.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for eorreetionihssue
Developer Impact Fee
Planning Approval
Called Contact Person,
A.I.P P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees