BELC2016-0073�t
,.t.
78-4951CALLE TAM PICO U 44mro
LA.QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: _ 6ELC2016-0073
Property Address: 45115 SUNBERRY CT
APN: 604412008
Application Description: BEGHTOL / CHANGE OUT MAIN BREAKER AND BUSSING
Property Zoning:
Application Valuation: $1,000.00
Applicant:
BRADLEY ELECTRIC INC
42215 WASHINGTON STREET
SUITE A381
PALM DESERT, CA 92211
LICENSED CONTRACTOR'S DEC. TI'O�
I hereby affirm under penalty of perjury that I am lice ed under provisions of Chapter
9 {commencing with,Section 7000) of Division 3 of the siness and Professions Code,
and my License is in full force and effect.
License Clas : CW License No.: 275466
Q�St Contractor-.
11
OW ER -BUILDER DECLARATION
I hereby affirm under penal of perjury that I am exe t -from the Contractor's State
License Law for the follov{ ng reason (5033. , Business and Professions Code: Any
city or county that requiZpecmiYto 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 theapplicant 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.).
(_) 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
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. Cl. .
Lender's
Lender's Addre
VOICE (760) 777-7125
FAX (760) 7774011.1
INSPECTIONS (760) 777-7133 .
Owner:
DANA BEGHTOL
45115 SUNBERRY CT
LA QUINTA, CA 92253
Contractor:
BRADLEY ELECTRIC INC
42215 WASHINGTON STI
SUITE A381
PALM DESERT, CA 92211
(760)360-0944
Llc. No.: 275466
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 worker:'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oA_ork for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
00 of the Labor Code, for the performance of the work for which this per nit
(is issued. My workers' compensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9084693
I certify that in the performance of the workfor wh�i Ihispermi�is issued, I '
shall not employ any person in any manner sous to bec a subject to the workers
compensation laws of California, and agree that, i eco bject to he
workers' co pensation provisions of Sectio 0 f the Lab Code, I sh
comply it those provisions.
rijlf'(A licant:
WARNING: FAILURE TO SECU E WORKERS' COM PENS N COVERAGE IS UNLAWPU
AND SHALL SUBJECT AN EM LOYER TO CRIMI ENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND LLA $ 000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CCDE,
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 whos e
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 suc ermit, o tion of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above inl rmation i!
I agree to comply with all city and county ordinances -and -.s l r ting to
construction, and hereby authorize representatives of this city nto enter u th
above-meetiortpd property for inspection purposes.. —\ r -
(Applicant or
Date: 9/!16
I
.
z:
o "'G
C.
nO`
rV
rn
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 worker:'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oA_ork for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
00 of the Labor Code, for the performance of the work for which this per nit
(is issued. My workers' compensation insurance carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9084693
I certify that in the performance of the workfor wh�i Ihispermi�is issued, I '
shall not employ any person in any manner sous to bec a subject to the workers
compensation laws of California, and agree that, i eco bject to he
workers' co pensation provisions of Sectio 0 f the Lab Code, I sh
comply it those provisions.
rijlf'(A licant:
WARNING: FAILURE TO SECU E WORKERS' COM PENS N COVERAGE IS UNLAWPU
AND SHALL SUBJECT AN EM LOYER TO CRIMI ENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND LLA $ 000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CCDE,
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 whos e
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 suc ermit, o tion of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above inl rmation i!
I agree to comply with all city and county ordinances -and -.s l r ting to
construction, and hereby authorize representatives of this city nto enter u th
above-meetiortpd property for inspection purposes.. —\ r -
(Applicant or
I
Date: 9/9/2016
Application Number:
BELC2016-0073
Owner:
Property Address:
45115 SUNBERRY CT
DANA BEGHTOL
Q APN:
604412008
45115 SUNBERRY CT
Application Description:
BEGHTOL / CHANGE OUT MAIN BREAKER AND BUSSING
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$1,000.00
Applicant:'
Contractor.
BRADLEY ELECTRIC INC
BRADLEY ELECTRIC INC
42215 WASHINGTON STREET
42215 WASHINGTON STREET
SUITE A381
SUITE A381
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)360-0944
---------------------------------------------------------------------------------------------
Llc. No.: 275466
Detail: CHANGE OUT MAIN
r
BREAKER AND BUSSING. 2013 CALIFORNIA BUILDING CODES.
I
FINANCIA
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION,
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT
101-0000-42403
0
$24.17
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT PC
1011-0000-42600
' . 0
$24.17
Total Paid for ELECTRICAL: $48.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85•
r
Total Paid for PERMIT ISSUANCE: $91.85
•
Bin #City
Permit
Project Address: /
of La Quirita ,
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
owner's Name: L.
A. P. Number:
Lddress:
Legal Description:
__
;Contractor:
41d
Com/ nn
l
City, ST, Zip:
hone:
_ o e.
P
�r
Address;
s
`
Pro'ec e
J
City, ST, Zip:
TeleP hone:
!.r
�*ttate Lic. # :
,r
fj
....City Lic. #c >:<:::> >s:'•s»
r J
— —
07,
Arch.,`Engr., Designer:
Address:
City, ST, Zip:
Telephone:
hone:
on T YP e: O P
Construction Occupancy:
Y:
t Lic. i�.
State a Lc,
Add'n Alter Repair
o tYPa circle one)New
DemMEN
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
stted Value of Project:.
# Submittal
APPLICANT: bO NOT E BELOW THIS LINE
Req'd Rec'd TRACKING PERMIT FEES
Plan Sets q
Plan Check submitted
Item
Amount
Structural Cafes.
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
Gran( Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'rd Review, ready for corrcctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
Total Permit Fees