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BELC2016-001178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4tr44vQumrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BELC2016-0011 I IIIIII "II� IIII III Property Address: 52303 ROSS AVE 09 APN: 767900008 Application Description: MADISON CLUB HOA / PEDESTAL FOR CAMERAS Property Zoning: (760)775-4855 Application Valuation: $2,000.00 Applicant: HEGGE ELECTRICAL CONTRACTORS INC 83852 AVE 45 INDIO, CA 92201 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.: 748171 (//] Date: 4 & Contractor: CQ C-C'N act / OWNER -BUILDER DECLARATION �C 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 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).: (—) 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.). (_) 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 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: Owner: EAST OF MADISON P 0 BOX 1482 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/18/2016 LA QUINTA, CA 0 ., Contractor: _ tom' HEGGE ELECTRICAL CONTRA, 6_RS INO 83852 AVE 45 INDIO, CA 92201 (760)775-4855 --=11. �� `� �' _ _ Llc. No.: 748171 WORKER'S COMPENSATION DECLARATION 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. 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: Polity Number: 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 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 Labor Code, I shall forthwith comply withthos provisions. Date: zeq Applicant ;�V_,W�� 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 of this city to enter upon the above-m37 d�7&signature y for inspection purposes. Date: (Applicant or Ag DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY. AMOUNT .PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE POWER APPARATUS 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD. RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE POWER APPARATUS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD. RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $48.34 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK.# CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 Description: MADISON CLUB HOA / PEDESTAL FOR CAMERAS CONDITIONS Type: ELECTRICAL Subtype: Status: APPROVED Applied: 2/18/2016 MFA Approved: 2/18/2016 MFA Parcel No: 767900008 Site Address: 52303 ROSS AVE LA QUINTA,CA 92253 Subdivision: TR 33076-1 Block: Lot: D Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $2,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 PHONE Details: INSTALL 100 METER PEDESTAL FOR HOA SECURITY CAMERAS PER 2013 CALIFORNIA BUILDING CODE. Applied to Approved CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT HEGGE ELECTRICAL CONTRACTORS INC 83852 AVE 45 INDIO CA 92201 SHERRYL@HEGGEELEC TRICAL.COM CONTRACTOR HEGGE ELECTRICAL CONTRACTORS INC 83852 AVE 45 INDIO CA 92201 SHERRYL@HEGGEELEC TRICAL. COM OWNER EAST OF MADISON P O BOX 1482 LA QUINTA CA 0 FINANCIAL INFORMATION Printed: Thursday, February 18, 2016 12:23:59 PM 1 of 2 r SYSTEMS DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD .BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: POWER APPARATUS 101-0000-42403 0 $24.17 $0.00 POWER APPARATUS PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 BOND INFORMATION Printed: Thursday, February 18, 2016 12:23:59 PM 2 of 2 r - ' . srsTEMs ,. 161 -Rai -bop (ter D Bin # tbt\. • City of La Quin to . Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012. Buil 'ng Permit Application and Tracking Sheet '1 Permit d'" `UL Project Address: ,5a — SS C�1/ii Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip:'IJa.dd'aj Contractor: ' 66* e,�, N c� �w i e. Telephone: ne: 0^ S 0 P 3 7 Address: :!> _ Auc, Project Description: City, ST, Zip: r �i a ® ( ►'�S �V V �!'!� psi /I C S'l`y �' Tele h ne 'n - o . '% S P �0 7 8 Em r v 40 �W eta State Lic. # City Lie. #; D 1 Arch., Engr., Designer: Address: City., ST, Zip: Telephone:hone: ....... ........... ......... ....................... ancY: TYPe•Construction. Occupancy: State to Lic. # Project type (circle one • New Add'n Alter Repairair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone #,of Contact Person:Estimated Value of Project: —� APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd TRACKING 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 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 Decd Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN If OUSE:- '`" 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 14' 2 -rlTY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FI -OR NSTRUCTION i c� DATE D LO By. CONDUIT & WIRE NOTES: CUSTOMER INSTALL (ONE) - 2 W1 SCH. 40 PVC CONDUIT (5') IID IN: 1/0 AL TRI. 120/240V,-- 1 PH FOR SEC. SERa/ICE "� 100A 100-C\ 120 w1 5, 0 A !40V � 1PH NOTE TO CUSTOMER: / PLEASE CONTACT IID INSPECTOR PRIOR TO UNDERMINING ENERGIZE STRUCTURE. 760-398-5828 PLEASE HAVE ADDRESS AND SERVICE •?,b11 NOTIFICATION NUMBER AT HAND. JOB SITE �AMUWDSOW' VICINITY MAP N.T.S. IMPERIAL IRRIGATION DISTRICT N 1 inch = 100 feet SUB: JEFFERSON CKT. N170 THE MADISON CLUB .&230 ROSS AVS LA QUINTA, CA 92253 SERVICE LAYOUT SERVICE NOTIFICATION:4020634 I SERVICE ORDER:60101071 I DRAWN BY:LMARRUJO I DATE: 01/25/2016 Hegge Electrical Contractors Inc. D INCOMING PVC 100 Amp Meter Fedlsta� Handho�e -2nd Gnd Rock 6'. To The West #4 CU