BELC2017-0113i
r
A
78-495 CALLE TAMPICO 4.4 Qumro
{ LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT
BUILDING PERMIT
' Permit Type/Subtype: ELECTRICAL/
Application Number: BELC2017-0113
i Property Address: 48235.5 VISTA DE NOPAL
APN:
Application Description: METER PEDESTAL UPGRADE'
Property Zoning:
Application Valuation: $4,000.00
' Applicant:
DON HEGGE ELECTRIC )
.43652 PALERMO COURT DEC.2 8 20V
LA QUINTA, CA 92253
CITY OF LA QUINTA
COMMUNITY DEVELOPM ENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C10 License No.: 91949
Date:' ^� Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt 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 ofthe 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).:
( ) 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 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.).
L) 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 am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY ,
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. CT
Lender's Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/28/2017
Owner:
ELLEN WOOLARD LAGUNA DE LA PAZ
HOMEOWNERS
LA QUINTA, CA 0
Contractor:
DON HEGGE ELECTRIC
43652 PALERMO COURT
LA QUINTA, CA 92253
(760)340-4000
Llc. No.: 491949
WORKER'S COMPENSATION DECLARATION • '
I hereby affirm under penalty of perjury one of the following declarations:
I have and will rrfaintain a4certificate of consent to self -insure for workers'
comp
ensatio s provided for by Section 3700 of the Labor Code, for the performance
of the wor or 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: PREFERRED EMPLOYERS INSURANCE COMPANY Policy Number:
WKN1247351
_ 1 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 become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the .
workers' compensation provisions of Section 3700 of the Labo de, I shall forthwith
comply with thosee provisions.
Dater V Applicant:
6/0
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). 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 Building Official 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 correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives oft s city enter u the above-
mentioned property for inspection purposes. /
1 �1
DateR � 'Signature(ApplicantorAgent):
FINANCIAL INFORMATION..
DESCRIPTION. ACCOUNT QTY AMOUNT
BSAS S61473 FEE 101-0000-20306 0. $1.00
Total_ Paid for BUILDING STAN DARDSADM IN ISTRATION BSA: $1.00
DESCRIPTION'•
ACCOUNT
QTY
AMOUNT
SERVICES
101-0000-42403
0 •
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
0
$13.00
Total Paid for ELECTRICAL: $39.01
DESCRIPTION
- .- ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE ('
101-0000-42404
0
$98.83
Totar Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total•Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0.
$S.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:
$153.84
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'Contractor-_ -Name: `
Construction -Type: Occupancy:
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City, St, Zip
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-PLAN LOCATION:
Froject Address: 7 ��3s�
Project'Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN#:
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Fire Sprinklers SF
Applicant Name:
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Address: F +
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Telephone:.
Email: r.
Valuation of Project $
'Contractor-_ -Name: `
Construction -Type: Occupancy:
-New SFD Construction:
Address: —7f t O cS
City, St, Zip
.Conditioned Space SF '
City, St, Zip 4
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Garage SF.
Telephone:
Ski WDb
Email"
Patio/Porch SF
Email:L
Fire Sprinklers SF
C.. AVI
Etate Lic:City Bus Lic:
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rarch/Eng Name:
Construction -Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:Bedrooms:
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Stories: i
# Units:
Email"
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State Lic: ' City Bus Lic:
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Property Owner's Name:
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New Commercial /Tenant Improvements:
Address:
Total Building .j . SF
City, ST, Zip
Construction Type: Occupancy:
elephone:
Email:
78495 CALLE TAMPICO "
LA-QUINTA, CA 922531
A ` 760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
•Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License