12-0570 (ELEC)-.� _ I.Q
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Application Number: -12-00000570
Property Address: 52707 HUMBOLDT BLVD
APN: 767-2007091-15 -34968 -
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
•4
_ y 67 e�h _4.1A4 - xI c
^' 5.770.5 LD t �s VOICE (760) 777-7012
FAX (760) 777-7011
..BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
Applicant: Architect or Engineer: ' DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
lPC Lic: No.: 915336
Date: 5/22/12
D t
3 2012
CITY 00 LA QUINTA
FINANCE DEPT.
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 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 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 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
I` AcrfrctiwM--��
WARNING: FAILURE TO SECURE WORKER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TOT 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 abo nfor ati correct. I agree to comply with all
city and county ordinances and state laws relating to building tru tion, an reby authorize representatives
of this county to enter upon the above-mentioned property for i purpose
S' ature (Applicant or Agen
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury that I lice ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 -of the Business a ;of ss s Code, and my License is in full force and effect.
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
License CI s: U nse No.: 915336
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: Co actor: -
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
NER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that Ixempt from the Contractor's State License Law for the
Carrier TRAVELERS Policy Number YJUB282D7797-12
following reason (Sec. 7031 .5, Business and essions Code: Any city or county that requires a permit to
_ I certify that, in the performan a of the work for which this permit is issued, 1 shall not employ any
r
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
the
person in any manner beco ubject 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 I should me s bject he 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 Labor Code, II II f with com ly 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 ($500).:
1 _ 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.).
(_ 1 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 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
I` AcrfrctiwM--��
WARNING: FAILURE TO SECURE WORKER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TOT 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 abo nfor ati correct. I agree to comply with all
city and county ordinances and state laws relating to building tru tion, an reby authorize representatives
of this county to enter upon the above-mentioned property for i purpose
S' ature (Applicant or Agen
LQPERMIT
Application Number . . . . 12-00000570
Permit ELEC-SERVICE CHANGE
Additional desc .
Permit Fee . . . . 33.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 11/18/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A
18.50
Special Notes and Comments
100 AMP ELECTRICAL SERVICE FOR COMMON
AREA, TRASH BUILDING, YARD LIGHTS FOR
LOTS 12-15, AND FOUNTAIN. 2010 CODES.
------------------------ --
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
1.00
Grand Total 34.50' .00 .00
34.50
LQPERMIT
Bin. #
City. of La Quints
. Ba110g 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.-Wnta, CA 92253 - (760) 777-7012
Building Permit Application" and Tracking Sheet
Permit #
"J
1
Project Address: �� ''`j0 �tl�l�r
Owner's Name:. OF
A P. Number
Address:
Legal Description:
Contractor:p` 1A 16'
City, ST, Zip: q/ /7
Telephone• 4M 7 3 ��
Address: r�Of �7 -
Project Description:
City, ST, Zip: �� �•
Telephonewe) f m- 3 a M
State Lia #: City Lic fR
�Q WI/4 `
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/x"11
Arch., Engr., Designer.
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Address:
City., ST. Zip:
Telephone:
State Lia #: :
..
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
..._ ..... r
Name of Coatarx Person
Sq. Ft.:
#Stories:
# Units
Telephone # of Contact Person: Z .
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Reed TRACMG PERMIT FEES
Ptgn Sets
Plan Check submitted
Item
Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calce.
Called Contact Person
Plan Check Balance
Tide 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'! Review, ready for correctionsrissue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
ILO.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''a 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