11-0760 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: `11-00000760
Property Address: 51910 AVENIDA VILLA
APN: 773-183-007-17 -000000-
Application description: ELECTRICAL .
Property Zoning: COVE RESIDENTIAL
Applioation valuation: 2000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CHAPPIE.CHRIS
51910 AVENIDA VILLA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153'
Date: 7/13/11
Applicant: Architect or Engineer:
Contractor: �''J t
BARTLETT .ELECTRIC, INC I
69116 CLUB ROAD
CATHEDRAL CITY, CA 922II4 ; C�'6
.(760)408-6485
Lia. No . • 455990
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I. hereby affirm under penalty of perjury that 1 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 Business 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: B -C10 cense No.: 455990
-
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
y
_ yate: l I n ontractor: -
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that Iam exempt from the Contractor's State License Law for the
Carrier STATE FUND ' Policy Number 0000187-2010 - - -
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires permit to
_ 1 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 should become 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 Call forthwit mply 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).:
Kate: I scant: .leAsm.
*�&RE
1_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe
structure is not intended or offered for sale (Sec. 7044, Businessand Professions Code: The
NG: FAI TO SECURE WORKERS' 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 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 forsale. 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,
(_ 1 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
_.
of La Quinta, its officers, agents and employees for any act or omission related to the work being
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 -
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 correct. I agree to comply with all
city and county'ordinances and tate laws relating to bu'Id' onstruction, and hereby authorize representatives
of this county to enter upo a above-mentioned prop inspection p ses.
ate:71/ I/ ignature (Applicant or Agent)
N
Application Number 11-00000760.
Permit . . . . . . ELEC-SERVICE
y
CHANGE
c
Additional desc
Permit -Fee . . . . 33.50
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date 1/09/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18:5000 EA ELEC_SVC
<=600V/<=200A
18.50
------------------------------------
Special Notes and Comments
CHANGE OUT SERVICE, LIKE FOR LIKE
(200
AMP) . 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 Quetta
Building 8T Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pen'nit #P.O.
l
Project Address:�M/
Ie-
Owner's Name: CA z, 5 Ch4Q,21
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 1-4 Qv/tit</J- e4 /GZ15
Contractor:, ,enE TT G7,C.%G L �
P - -2,9 ;<:>:• <.<::;;:•:>:.: ;:::: ;< >
Tele hone: %�»>:<:>v;>`�:~r:�:�><:s.>:;^.•
Address: v
Project Description:
City, ST, Zip:
Telephone: .
740 -
�}:j��i; •i:•ii:.iv+w1:v G$:, tiS�:v':.i:? �f
::.:•;;>4:J:r r......:::i:i.i:.,.
pry.:.., :f:«:> ::.:<`
State Lie. # : $5 a
City Lie. #c
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
uz;:�::>:;:�,,.:<m>:<:;<>:>;:>z::as.r;:::z:::>:Construction
Type:. Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter epair Demo
Name of Contact Person:SRAWN FA277 %
Sq. Ft.:#Stories:
#Units:
Telephone # of Contact Person: D 171'- (ol
Estimated Value of Project: GIDS
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
TERMIT 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
Title 24 Calcs.
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