12-0001 (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:
12-00000001
51615 AVENIDA VELASCO
773-133-017-5 .-=0.00000-.
ELECTRICAL
COVE RESIDENTIAL
2050.
.Architect or EngineE
-1 h
LICENSED CONTRACTOR'S DECLARATION
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BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
• 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.
Lic
ensed dC� l�aass�: CIO License No.: 748171
Date:,_►_ 7 f_ j Contractor
J OWNER -BUILDER DECLARATION • '
1 hereby affirm under penalty of . ry that I am exempt from the Contractor's State License Law for the `
following reason (Sec. 7031. , usiness 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).:
1 _ 1.1, 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 yearof 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 licensedcontractors 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: 1/03/12
Owner:
JDT SDG -INV
P O BOX 1177
EL CENTRO, CA 92244'
Contractor:
HEGGE ELECTRICAL CONTRCTRS
83852 AVENUE 45
•'INDIO, CA 92201
(760)775-4855
Lic. No..: 7.48171
INC
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 performanceof the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as iequired 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 BENCHMARK INS Policy Number CST5002276
_ 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
3700'0f the Labor Code ,I -shat orthwith c=ply�vith Lose provisions.
Date: j 3 Applicant:
WARNING: FAILURE TO SECUR W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T R AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000).-E ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
K r 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 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 courpytq enter upon the above-mentioned property for i ec i n purposes.
Coate: /Signature (Applicant or Agent): _
Application Number 12-00000001
Permit . . . ELEC-SERVICE CHANGE
Additional desc .
: Permit'Fee . . . . 33..50 Plan Check Fee
.00
Issue Date .. Valuation. . .
0 '
Expiration Date 7/01/12
. Qty Unit Charge Per
Extension
BASE, FEE"
15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A
18.50
Special Notes and Comments
125A METER CHANGE OUT - 2010 CALIFORNIA•
ELECTRICAL CODES.
January 3, 2012 1:47:35 PM AORTEGA "
-------- - - - - -- -
--------"-----------------------
Other Fees . . . . . .BLDG STDS.ADMIN (SB1473)
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
Bin # • �:.
... .. , .. , , . ..
Ciof La Qurnta
Building 8t Safety Division .
P.O. Box: 1504, 78-495 Calle Tampico
La Quinta, CA'92253 - (760) 777-7012
Building Permit Application and Tracking Sheet .
Permit # -
Project Address elets t
Owner's Name:
A. P. Number:
Address:
Legal Description:
� City; ST, Zip:
Coptractor. 2
Teip`�hone:
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Address: (��
Project Description: e a e
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City, ST, Zip: O C '(Z?id
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Telephone: 5 ya
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State Lie. # : -7
City Lie. #:
Arch., Engr., Designer.
'
Address:
I
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Tyne Occupancy
Project type circle one). New Add'n Alter Repair
Demo
Sq. FL:-T##Stories:
Units:
Telephone # of Contact Person:
Estimated Value of Project: 1,05C± ese .sW
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMrr FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan CheekDeposit
Truss Cales.
Called Contact Person
Pian Check Balance
Title 24 Cales.
Plans picked up
Contraction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctioas/issu
Electrical
Subcontactor List
Called Contact Person
Plambing
Grant Deed
Plans picked up
S M L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue /L
School Fees
if -Ell IF
Total Permit Fees