13-0555 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4&t 4 4a Q" S
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000555
Property Address: 5138-0—CALLE;JACUMBA
APN: 770-166-006-.19 -000000-
Application description: ELECTRICAL
Property Zoning: MEDIUM DENSITY RES
Application valuation: 2000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
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 ess and Prof nals Code, and my License is in full force and effect.
License Cl ss: I
�C(1�0 Lice�n No.: 965837
Date: eW I�ontractor: ,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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).:
(_ 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
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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDINGAGENCY
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
Owner:
GIRDLESTONE JAMES I
51380 CALLE JACUMBA
LA QUINTA, CA 92253
Contractor: D
TROMBINO, JOSEPH
73535 JOSHUA TREE STR I
PALM DESERT, CA 92260
(760)272-0837
Lic. No.: 965837
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/01/13
MAY 012013
D
CITY OF LA QUINTA
FINANCE DEPT.
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 of the work for which this permit is
issued.
1 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
insurance carrier and policy number are:
Carrier MARKEL INS Policy Number MWC0030001
I certify that, in the performance of the wo r which this permit is issued, I shall not employ any
person in any ma so as to beco subje t to the workers' compensation laws of California,
and agree that, ' 1 shou com�bjo.rkers' compensation provisions of Section
—37700,of thhLa_ or Code, I shh those provisions.
Dater dl/1/�Ap—pl'icanc
WARNING: FAILURE TO SECURE COMPENSATION 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 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 co ree to comply with all
city and county ordinances and state laws relating to b struction, and ereby 'ze representatives
of this con toe er upon the.abov_e-mentioned prop y for inspe n pur ses.
Date:J i'h I Signature (Applicar.Agent):
LQPERMIT
Application Number . . . . . 13-00000555
Permit . . . ELEC-SERVICE CHANGE
Additional desc . .
Permit Fee . . . . 33.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/28/13
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
REMOVE EXISTING 100 AMP METER MAINE
SERVICE UPGTADE TO 200 AMP METER MAIN
SERVICE WITH UPGRADED FEED USE TWO
GROUNDRODS W/ #6 BOND TO METER SERVICE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDs ADMIN (SB1473)
1.00
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
1.100
Grand Total 34.50 .00 .00
34.50
Bin #
City of La Quinta
BulkUng sz Safety Division
P.O. Box 1504,:78-495 Calle Tampico
I.a.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
2
J
Project Address: 5-1 Nob
Ownees Name: .
A. P. Number.
Address:
Legs! Description:
City, ST, Zip;
41�064qv
Contractor.��
Telephon : ! (00
Address. S OS S
Project Description: l S
City, ST, Zip: '1 (� /� (� ?<
W 01- 1� vr�
Telephone
CQ� ,
cz
r � .
State Lja # :/ City Lia #;
Arch., EaU., Designer.
Address:
City, ST, Zip:
Telephone:
State Lia #:
Construction Type:.-
Project type (eirde one): New Add'n Alter Repair Dano
Name of Contact Person: Q�
Sy, �: #Stories:
# Units:
Telephone i of Contact Person: 66 a 7 Esdtnatea Value of Projoci:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N 1 Submittal Req+d Reed TRACKIIVG PFAMrr Fid
Pipe Sets an Check Submitted Itrm Amount
Structural Cales
Reviewed, ready for corrections Plan Check Deposit.
Truss Cala.
Called ContM6 Palm Plan Check Balance
'title 2/ Cats.
Pians picked up Construction
Flood plain Piga
Plans resubmitted Mecha"
Grading plan
X` Review, ready for correctionsfrssue Elect ital
Subcoatector List
Called Contact Person Plumbing
Grant Deed
Plans pieced up SM.I,
U.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
''' Review, ready for correctionslissue Devdoper Impact Fee
Planning Approval
Called Contact Person A,I,p.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
4