BELC2015-004478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BELC2015-0044
Property Address:
54935 SHOAL CREEK
APN:
775141074
Application Description:
PGA / GART / MOVE 100 AMP PANEL TO NEW LOCATION
Property Zoning:
a.
Application Valuation:
$1,972.00
Applicant:
BRADLEY ELECTRIC INC
42335 WASHINGTON STREET
SUITE F #381
PALM DESERT, CA 92211
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed rovisions of Chapter
9 (commencing with Section 7000) of Division 3 of the B in and Pro ions Code,
and my License is in full force and effect.
License_ as�s/:�C 0y License No.: 275466
Date:�L' LJ l Contrac
I hereby 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.).
(_) 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 Add
VOICE (760) 777-7125,
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Owner:
MARK GART
54935 SHOAL CREEK
LA QUINTA, CA 92253
Contractor:
BRADLEY ELECTRIC INC
42335 WASHINGTON STREET
SUITE F #381
PALM DESERT, CA 92211
(760)360-0944
Llc. No.: 275466
Date: 6/10/2015
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
c t r or which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Section 3700 of the Laboy 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 forth -t ' ermit is issued,
shall not employ any person in any manner so as to bec a subject to th workers'
compensation laws of California, and agree that, if I sh uld become subjec to the
workers' compensation provisions of Section 370 abor Code, I forthwith
comp) with th se provisions.
DatZA\D I Applic
WARNIN .FAIL E TO SECURE ORKERS' CGMPrNSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER -TO CRIMINAL PENALTIES 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 Building Official 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, anc
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.l have read this application and state that the a ove information is cor ct
I agree to comply with all city and county ordinances and state ws relating to buil nt
construction, an hereby authorize representatives of this city to e r upon the a
mentione prop y for ins ction purposes.
Date: Signature (Applic gent .
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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
c t r or which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Section 3700 of the Laboy 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 forth -t ' ermit is issued,
shall not employ any person in any manner so as to bec a subject to th workers'
compensation laws of California, and agree that, if I sh uld become subjec to the
workers' compensation provisions of Section 370 abor Code, I forthwith
comp) with th se provisions.
DatZA\D I Applic
WARNIN .FAIL E TO SECURE ORKERS' CGMPrNSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER -TO CRIMINAL PENALTIES 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 Building Official 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, anc
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.l have read this application and state that the a ove information is cor ct
I agree to comply with all city and county ordinances and state ws relating to buil nt
construction, an hereby authorize representatives of this city to e r upon the a
mentione prop y for ins ction purposes.
Date: Signature (Applic gent .
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FINANCIAL INFORMATION
DESCRIPTIONS1
ACCOUNT k _.Q
TY
Y :
AMOUNT
�. PAID PAID DATE
.'�
;
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00 6/10/15
s <*' AID BY: ^'
z.
�", _, 'WETHOD 4 ?� F�
i. -,RECEIPT # '
` ,CHECK# 'CLTD.BY
BRADLEY ELCECTRIC
CHECK
R6928
40446 SKH
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
;DESCRIPTION.. 'r
qty
"'
Q TY
'AMOUNT
PAID'
-
PAID DATE=
, ...
,ACCOUNT
>,_. . ,. z
OTHER ELECTRICAL EQUIPMENT
101-0000-42403
0
$24.17
$24.17
6/10/15
METHOD
=RECEIPT # '+
•CHECK #
-'CLTD BY
BRADLEY ELCECTRIC
CHECK
R6928
40446
SKH
`. DESCRI,P,TION. s
'w �''ACCOIINT p
CITY
AMOUNT
"PAID' j ''
PAID DATE:_
OTHER ELECTRICAL EQUIPMENT PC
101-0000-42600
0
$24.17
$24.17
6/10/15
br,. PAID.BY a ,�
tY ,. x:"METHOD
_w, 'RECEIPT;#
c CHECK#
CLTD BY _
BRADLEY ELCECTRIC
CHECK
R6928
r 40446
SKH
Total Paid forELECTRICAL: $48.34 $48.34
DESCRIPTIONS
'ACCOUNT '
"QTY
AMOUNT
PAIp * �...
PAID DATEe
�t
k
PERMIT ISSUANCE
.101-0000-42404
0
$91.85
$91.85
6/10/15
xPAID BY' `
?` z METHOD y
''Y RECEIPT #a
41 CHECK.#
CLTD BY
BRADLEY ELCECTRIC
CHECK
R6928
40446
SKH
Total Paid for PERMIT ISSUANCE: -$91.85 $91.85
TOTALS:
'
'
Description: PGA/ GART/ MOVE 100 AMP PANEL TO NEW LOCATION
Type: ELECTRICAL
Subtype:, Status: APPROVED
Applied: 6/10/2015 SKH
Approved: 6/10/2015 SKH
Parcel No: 775141074 Site Address: 54935 SHOAL CREEK CA
Subdivision: TR 20717-3
Block:. Lot: 2
Issued:
Valuation: $1,972.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: ELECTRICAL - RELOCATE ELECTRICAL PANEL FROM BATHROOM TO HALLWAY. 2013 CALIFORNIA BUILDING CODES.
0
ADDITIONAL SITES
CHRONOLOGY
CQNPITIQNS
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FINANCIAL INFORMATION
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PEI'111'it Details PERMIT NUMBER i
City of La Quinta
:B E LC -2011510044 f 1
:•;,. ;
IDE
;DESCRIPTION •
1: ,:;":x '. i:;.- ,�
ACCOUNT
QTY
•, . .� ,
7 -
'AMOUNT„ -
�
PAID
PAID DATE
RECEIPT #.
CHECK # s'
METHOD-"
PAID BY,
D
Fu
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/10/15
R6928
40446
CHECK
BRADLEY ELCECTRIC
SKH
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA: �.
OTHER ELECTRICAL
101-0000-42403
0
$24.17
$24.17
6/10/15
R6928
40446
CHECK
BRADLEY ELCECTRIC
SKH
EQUIPMENT
OTHER ELECTRICAL
101-0000-42600
0
$24.17
$24.17
6/10/15
R6928
40446
CHECK
BRADLEY ELCECTRIC
SKH
EQUIPMENT PC
Total Paid for ELECTRICAL: — $48.34 $48.34
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/10/15
R6928
40446
CHECK
BRADLEY ELCECTRIC
SKH
Total Paid forPERMIT ISSUANCE: $91.85 $91.85
TOTALS:
PARENT PROJECTS
:• • INFORMATION
[ i
Printed: Wednesday, ,lune 10, 2n15 9-waF am 2 of 2 J ,
SY57EM5
t
Bin #
City of La Quinta
Building 81: 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: _
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Owner's Name:'
A. P. Number:
Address:
Legal Description:
Contractor:
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F
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City, ST, Zip:LA efv)-y7wt
Telephone:
Address:
Project Description:
City, ST, Zi :
LQ
& C_ffin
6Tl /W 4
Telephone:
l
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
or
Address:
City., ST, Zip:
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Telephone:
one:
>:
.
Con stmcti n Type: e• P
Y P Occu ane
State Lic. #
ProJ'e ct a (circle one New d'
h'P � Ad n Alter Repair r Dem 0
Name of Contact Person:
Sq. Ft.:#Stories:
# Units:
'Telephone # of Contact Person:
Estimated Value of Proiec I O-0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees