09-0018 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00000018
Property Address:
54845 AVENIDA HERRERA
APN:
774-302-015-6 -000000-
Application description:
ELECTRICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3000
T4hf 4 4 a"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
I
BUILDING PERMIT �Owner: L 0S
100g
PREFERRED PROP RTIESOMYOFLA
73000 FRED WARI PTA
PALM DESERT, CA 92211
--------------------------------------------------
LICENSED CONTRAC OR'S DECLARATION
I hereby affirm under penalty of perjury that I am Ii ed and rovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and P o ssional ode, and my License is in full force and effect.
License Class-sCl ense No.: 536093
(r
ate: � l � rector.
R -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am mpt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions 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, 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
improvement s.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.).
I _ 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: Ir
LQPERMIT
Contractor:
MIRAGE ELECTRIC
19400 FORD AVENUE
DESERT HOT SPRINGS, CA 92241
(760)408-3125
Lic. No.: 536093
------------------
WORKER'S COMPENSATION DECLARATION
VOICE (760) 777-7012
X (760) 777-7011
:TI (760) 777-7153
1/08/09
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.
YJ 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 ENDURANCE INS Policy Number WEN003472601
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to becomes bject to the workers' compensation laws of California,
and agree that, if I should beco sub' t to the workers' compensation provisions of Section
J00 of the Labor C e forth th comply with those provisions.
moo, a✓te::L �0plicant:
WARN G: FAILURE TO SECUR RRKE ' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. IN ADDITION TO THE 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 above information is cdrr I agree to comply with all
city and cou y ordinances and state laws relating to building constructio nd he y authorize representatives
of this co o enter upon t above-mentioned property for inspecti purpos -
ature (Applicant or Agent):
Application Number .
. . . . 09-00000018
Permit . . .
ELEC-SERVICE
CHANGE
Additional desc .
Permit Fee . . . .
33.50
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
7/07/09
Qty Unit.Charge
Per
Extension
BASE
FEE
15.00
1.00 18.5000
EA ELEC
SVC <=600V/<=200A
18.50
----------------------------------------------------------------------------
Special Notes and Comments
UPGRADE & CHANGE OUT
FROM 100 AMP
TO 200
AMP OVERHEAD FEED
----------------------------------------------------------------------------
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 Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:/2
-vz4 aE k/ C
Telephone:
Address: d
Project Description:
City, ST, Zip: j �
'—
Telephon l
vi "'—
State Lic. #: CIS —&
City Lic. #:
-74 5,C; C
Arch., Engr., Designer:
Address: '
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 3 coo
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd
TRACKING
PERMIT FEES
Plan Check submitted
Item Amount
l Calcs.
Reviewed, ready for corrections
Plan Check Deposit
FEReq'd
cs.
Called Contact Person
Plan Check Balance
alcs.
Plans picked up
Construction
in plan
Plans resubmitted
Mechanical
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