06-2865 (ELEC)'.Q
P.O., BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:06==0-0002$65'"
Property Address: 522 05+AVENIDA~ VALLEJO
APN: 773-222-021-10 -000000-
Application description: ' ELECTRICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 1500.
Applicant: Architect or Engineer:
Nt
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
VANDEN GOOGEN
52205 AVENIDA VALLEJO
LA QUINTA, CA -92253
Contractor:
HEGGE ELECTRIC, DON
77760 COUNTRY CLUB DR, STE D,
PALM DESERT, CA 92211
(760)200=5981
Lic. No.: 491949
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
L'J
Date: 8/01/06
AUG o 12006
Cli OF Ll.O(111,,.
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LICENSED CONTRACTOR'S DECLARATION
-------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am license under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division -3 of the ' ess and Prof si als Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
license Class: C10 License No.: 491949
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/►
ate: 'y ontractor. -
E 49
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
OWNER -BUILD ECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier PREFERRED INS Policy Number WKN1247352
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any man r as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if shout become s lec o the workers' compensation provisions of Section '
• License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Lab o shall fo comply with those provisions.
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 (55001:
e: 'cant
(_ 1 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSA COVERAGE IS UNLAWFUL, AND SHALL '
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
improvements are not intended or offered for sale. 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 he or she 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,
(_) I 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
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
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 tbeveformatio ' orrect. I agree to comply with all
cityand county ordinances and state laws relating ttruction a hereby authorize representatives
of this co�un�ty/too center upon th above-mentioned pection ur oses.D� l��I[J�e ' ature (Applicant or Agent)
LQPERnIIT -
Application Number. . . . . .. 06-00002865
Permit . . . ELEC-SERVICE
CHANGE
- Additional desc
Permit Fee 33.50,
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date 1/28/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00, 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
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Special Notes and Comments
-------------------------
INSTALL NEW 200 AMP METER PANEL
Fee summary Charged-
Paid Credited
Due
Permit.Fee Total 33.50
.00
.00
33.50
Plan Check Total .00
.00
00
.00
Grand Total 33.50
.00
.00
33.50
LQPERnIIT -
Bin #
City of La Quinta
Building & 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: -- 22 0 c� M
Q<, '
Owner's Name: U
A. P. Number:
Address: S ZZ O ,!�_ pyu e— '
Legal Description:
Contractor:
City, ST, Zip: C 2-Z
Telephone:
Address: dfi'r
ject Description:
City, ST, Z * ip
kU (2k eaZ I(
q
Telephone:
City Li,. #: v
State Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ._ `
State Lic. #: j x
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:# Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: °`'
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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:-
'`d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
A