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06-1048 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00001048 Property Address: 53980 GRAY AVE APN: 767-200-998-75 -330761- Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2500 4 BUILDING & SAFETY DEPARTMENT R_*_� ILDING PERMIT Applicant: Architect or Engineer: Mq ky X41333 G 4A Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 Contractor: BRUDVIK, INC. 600 EUGENE.ROAD PALM SPRINGS, CA 92264 (760)320-4429 Lic. No.: 482623 . VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/07/06 ------------------------------------------------------------------------------------------------- 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 Business and fessionals 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 Licens 1 s: 10 C20 C3 License No.: 482623 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - issued. Date) // Co tractor: T211M % — 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 INS CO OF WEST Policy Number WSD21878101 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 b come 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 uld 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 700 of the La r de,rthwith 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 J any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: f Date(/� A plica 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 W RKERS' COMPENSA N 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 1$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.). ( 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: LQPERDIIT 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 abov inform on is correct. I agree to comply with all city and county ordinances and state laws relating to buil • ing onstr o nd hereby authorize representatives .of -this un to ter upon the above-mentioned prope r i do urposes. Date: / Signature (A licant or Agent): LQPERIIIT 0 Application Number . . . . . 06-00001048 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 52.50 Plan Check Fee 13.13 Issue Date . . . . Valuation 0 Expiration Date— 10/04/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 37.5000 EA ELEC SVC <=600V/>200A/<=1000A 37.50. ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL SERVICE #5 800 AMP SERVICE 277/480V 3PH 4W, (MAINTENANCE BLDG.) 2001 CBC,2004 CEC CODES. Fee summary Charged Paid Credited Due ----------------- ---------- ------ --- ---------- ---------- Permit Fee Total 52.50 .00 .00 52.50 Plan Check Total 13.13 .00 .00 13.13 .Grand Total 65.63 .00 .00 65.63 11 Bin City of La Quinta Building u Safety Division Permit.# P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760.) 777-7012 ob., 1 049Building Permit. Application and Tracking Sheet Project Address:' S3 CIYO ,n U L Owner's Name: I A. P. Number: _ Qq _ 116Address: �O✓� t &11"h G L(C'd' Legal Description: i- 33 07 City, ST, Zip: S 3 S 11 C� 3 Contractor: Telephone' Wo -3 � 1--5oz r Address: QQ•v . e f Project Description: O City, ST, Zip: • U S 4"I�t C `'� ` �'L4 . j Telephone:760 32 d . w I State Lic. # :4— 6.3Z . City Lic. #: �� Id Arch., Engr:, Designer: • �� Address: City, ST, Zip: Telephone: "° onstruction Type: Occupancy: f State Lic. #: Project type.(circle one): New Add'n Alter. Repair Demo Name of Contact Person: Sq. Ft.': #Stories: #Units: 'Telephone # of Contact Person: Fes' f Project: 7z S� APPLICAR'LINE # Submittal Req'd PERMIT FEES Plan Sets n Item Amount Structural Calcs. v Plan Check Deposit Truss Calcs. • Q Plan Check Balance Energy. Calcs.��111��' Construction Flood plain 1 plan Mechanical Grading.plan C Electrical Subcontactor List �umbing Grant -Deed T.I. H.O.A. Approval Grading . IN HOUSE:- _ onssue �' /� Developer Impact Fee Planning Approval _...act Person. A.LP.P. Pub. Wks. Appr Date of permit issue ' School Fees Total Permit Fees