10-0395 (ELEC). P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
• /05/10
Application Number: 10-0000039 ' 5 Owner:
Property Address: 51830 AVENDA VILLA LARSON, TOD
APN: 773-183-024-21 -000000- •' 51830 AVENIDA VILLA C'.
Application description: ELECTRICAL :77—
LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL =
Application valuation: 1500 Q
— _ _ �._ -----_—___. _ _._. __._ _ .---••--,----__— _ T _ _-- ---- __
-----Contractor: _ .. ... _ _ ...... � r
Applicant: Architect or Engineer: BRANNEN ELECTRIC s
46324 ROUDEL LN D
LA QUINTA,CA 92253
may✓ (760) 347=3829
Lic. No.: 376189
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed 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 Busi ess and Professionals 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.: 376189 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
Dater Contractor: _ 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 -BUILDER DECLARATION 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 STATE FUND Policy Number 3009487-2010
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 manner so 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 I sh Id ecome subject to 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 labor d shall for ith 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 ($500).: Date: Applicant:
(_) 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 WOr
COMPENSATION 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 CRIMINLTIES 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 -
(_) I, 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. BAP.C. for this reason 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. '
Date: - Owner: .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
CONSTRUCTION LENDING AGENCY permit to cancellation. w
hereby affirm under penalty of perjury that there is a construction lending agency for the performance.of the I certify that 1. have read this application and state that the ab ve information is correct. I agree to comply with all `
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to.buildi construction, and hereby authorize representatives
of this county to enter upon the above-mentioned prope r inspec ' purposes. _
Lender's Name:
Oate<S /D .:Signature (Applicant or Agent):
-Lender's Address: -
LQPERMIT
x: Application Number . . . . 10-00000395
:'. Permit` ELEC-SERVICE CHANGE'
Additional desc -
Permit`Fee 33.50 Plan Check Fee
.00
Issue Date Valuation
0 '.
Expiration Date 11/01/10
Qty Unit Charge Per:;
Extension
BASE FEE
15.00 .
1.00 18.5000 EA ELEC SVC <=60OV/<=200A
--------------------
18.50
-,i_ - - - - - - - ---------------------------------
- - - - - - - - -'- - - - - - - - - - -
Special
Special Notes and Comments
- - --
_
" ELECTRICAL PANEL SERVICE CHANGE TO -
UNDERGROUND -2 0 OAMP -APPROVED --PER -A'-J
------------------------------------------ ------------------
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
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Bin #
City of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sneet
Permit #
Project Address: _
Owner's Name: �
A. P. Number:
Address:
Legal Description:
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Contractor: /
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City, ST, Zip:
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Telephone: ;
Project Description:
Address:
City, ST, Zip: , f
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Telephone:
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State Lie. # :
City Lie. #:
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
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Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair.. Demo
Sq. Ft.: #Stories: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project: .�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACMG
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
Tide 24 Cales.
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
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees