13-0166 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000166
Property Address:
52707 HUMBOLDT BLVD
APN:
767-200-091-15 -34968 -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
Tii�v 4 4a
GV S�N�EO
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
App'cant: ArchiteXZeer:_
14-
--------------------------------------------------
LICENS CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m i nsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a d essi n de, and my License is in full force and effect.
License Class: B Licens o.: 915336
•
—Date Contractor:
`-- O -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am a pt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Profe ns 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 1, 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Fte-4m;VOF
Date: 2/12/13
Owner:EAST OF MADISON LLC
PO BOX 14823 �Q180955 AVE 52LA QUINTA, CA 92247LAQUI?4
Contractor:
DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
Lic. No.: 915336
-----------------------------------------------
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.
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
insurance carrier and policy number are:
Carrier TRAVELERS Policy Number YJUB282D7797-12
_ I certify that, in th4WORKERS'
an the work for which this permit is issued, I shall not employ any
person in any mas o com to the workers' compensation laws of California,
and agree that, b e su Jett tot orkers' compensation provisions of Section
30 of the LaI s ath comply ith those provisions.
Dat Applicant
WARNING: FAILURE TO SECUERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CPEN S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADTHE ST 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 i for n is correct. I agree to comply with all
city and county ordinances and state laws relating to building c for
on, hereby authorize representatives
of this county to enter upon the above-mentioned property for i ec ' purpos
Date•�Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 13-00000166
Permit ELEC-SERVICE CHANGE
;
Additional desc .
Permit Fee 33.50 Plan Check•Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 8/11/13
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
16-19. AND FOUNTAIN•2010 CODES. APPROVED
B.H.
-----.-------------_-_-------------------------------------------------
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
Bfn.#
Permit #
Project Address:
City of LCT Qi(lhta
Building u Safety Division
P.O.'Box 1504,78-495 Calle Tampico
U.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Ownees Name:
A. P. Number.
Address: f `i
Legal Description: f�
Contractor. 07CC''ww 040&/ /�tr40/ i
City, ST, Zip:
Telephone:
Address: 0044-
Project Description:
City, ST, Zip: v� t W
Telephon
State Li'S
Arch, Engr., Designer.
Lie',#
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:vow
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
- R.Sq. Ft.: # Ston, #Unit
Telephone* of Contact Person:zoo:-
' ?j Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Rec'd
TRACfCIrIG PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Strgctural Calc&
Reviewed, ready for corrections Plan Check Deposit, .
Truss Calca•
Called Contact Person Plan Check Balance
Title 24 Cities.
Plans picked up Construction
Flood plain plan
Pians resubmitted.'. Mecha"
Giading plan
V Review, ready for corrections/issue Electrical
Subcoutactor List
Called Contact Person Plumbing
Grant Deed
Pians picked up ML
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE.-
3" Review; ready for eorreedons/issae Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees