BELC2017-0063LICENSED 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.: 881356,, t
Date: –7 Contractor: j/111r�Pi1 G. \�C
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 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.).
( 11, 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. . BAP.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 i5 issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's
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
oftk 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: BENCHMARK INSURANCE COMPANY Policy Nu r: CSTS00863S
I certify that in the performance of the work for w this permit is issued, I
shall not employ any person in any manner so as to bec 1ect to th workers'
compensation laws of California, and agree that, if I sh I c e subj ct to the
workers' compensation provisions of.Section 3700 of e o Co e, I all forthwith
comply with t se provisions.
Date: C� Applicant:
WARNING: FAILURE TO SECURE WORKERS' C PENSATI N COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ES 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 Quint@, 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 voi f work is
not commenced within 180 days from date of issuance of such permit, o cessation of
work for 180 days will subject permit to cancellation. /7
I certify that I have read this application and state that the above
I agree to comply with all city and county ordinances and state I
construction, and hereby authorize representatives of this city t
above-mentioned property for inspection purposes.
•
Date: % I 7 Signature (Applicant or Agent):
]
� O�i
VOICE (760) 777-7125760
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA 92253
fAX ( ) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/11/2017
Application Number: BELC2017-0063
Owner:
Property Address: 47330 CALEO BAY
LAKE LA QUINTA HOMEOWNERS—� , z
APN: 643200012
P 0 BOX 1398
Application Description: LAKE LA QUINTA HOA /
CHANGE OUT (1) PEDESTAL
PALM DESERT, CA 0 M1 a
5 o
Property Zoning:
o
Application Valuation: $1,200.00
�� cv d L
® S o
Applicant:
DRIVEN ELECTRIC INC
LL -
Contractor: G ' J o
DRIVEN ELECTRIC INC �(,�, c5
72078,CORPORATE WAY STE 105
72078 CORPORATE WAY STE 105
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276 o
t�–�
(760)343-3222
Llc. No.: 881356
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.: 881356,, t
Date: –7 Contractor: j/111r�Pi1 G. \�C
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 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.).
( 11, 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. . BAP.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 i5 issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's
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
oftk 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: BENCHMARK INSURANCE COMPANY Policy Nu r: CSTS00863S
I certify that in the performance of the work for w this permit is issued, I
shall not employ any person in any manner so as to bec 1ect to th workers'
compensation laws of California, and agree that, if I sh I c e subj ct to the
workers' compensation provisions of.Section 3700 of e o Co e, I all forthwith
comply with t se provisions.
Date: C� Applicant:
WARNING: FAILURE TO SECURE WORKERS' C PENSATI N COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ES 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 Quint@, 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 voi f work is
not commenced within 180 days from date of issuance of such permit, o cessation of
work for 180 days will subject permit to cancellation. /7
I certify that I have read this application and state that the above
I agree to comply with all city and county ordinances and state I
construction, and hereby authorize representatives of this city t
above-mentioned property for inspection purposes.
•
Date: % I 7 Signature (Applicant or Agent):
Application Number:
-BELC2017-0063
Property Address:
47330 CALEO BAY
APN:
643200012
Application Description:
LAKE LA QUINTA HOA / CHANGE OUT (1) PEDESTAL
Property Zoning:
Application Valuation:
$1,200.00
Date: 7/11/2017
Owner:
LAKE LA QUINTA HOMEOWNERS AS
P O BOX 1398
PALM DESERT, CA 0
Applicant: Contractor:
DRIVEN ELECTRIC INC DRIVEN ELECTRIC INC
72078 CORPORATE WAY STE 105 72078 CORPORATE WAY STE 105
THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
(760)343-3222
Llc. No.: 881356
Detail: CHANGE OUT (1) ELECTRICAL PEDESTAL. 2016 CALIFORNIA BUIL15ING CODES
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:' $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
POWER APPARATUS
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
POWER APPARATUS PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT'
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT -
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
.0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #Qty of la Quin to
Building 81• Safety Division
Permit #{ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: -`AT330 CAPO Owner's Name: �� LA of ,+
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 9&4A, vis 4_ Ci -92-4-Zl TZZ4iZl
p�
Contractor:lac
'<.1xC. i �
Telephone:
Address: �LQTs &
V5
Project Description:
City, ST, Zip:
Paws
e h n . /_�
T le o �2
P ill! 3 Z
e F - n �
.�, V C � T
State Lic. # : jS��j �Q
City Lie. VD 06 ZD..
Arch., Engr., Designer:
Address:
City, ST, Zip:
ane
e' C Occupancy:
:Telephone: Construction
TY P r'C P
State ic.#.
Alter Demo
Project type (circle one): New Add'n
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: (2o cJ
4 Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rcc'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
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 Aced
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Jrd Review, ready for corrcctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks- Appr
Date of permit issue
School Fees,
Total Permit Fees
O
ITJn
r
r
0
.
CALEO BAY DR.
0
C
y o0
w >
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6
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C
OF LA QUINTA
c
BUILD
NG & SAFETY DEPT.
PROVED
FOR
CONSTRUCTION
DATF,By
L
_
ADAMS ST
SLD
480V House Meter Pedestal Replacing same for same
(47330 Caleo Bay Dr)
i 00 )
main bre6
Utility
480V/100A - Irrigation Pump
480V/30A - Fountain Pump
180V/50A - Step Down Transformer (for landscaping/lighting)
2 Ground rods 6ft apart
or
i�uw4�eNn� Cwr��Fwn t7nwr.we.w1
DI atcr..........�..... �............
c�a ` 1�81600 AVENUE 58
QUI
LA QUINTA. CA 42253
_............. �......... ...p........ _ ,
SERVICE NOTIFICATION `(402=1358''^` BP 3023070
,. S
SERVICE ORDER -60110634 CA 20026006
:1i,'ra+n'o(.eTt^'r:'
DATE 0711 17 CITY A 1NTA
APPLICANT INFORMATION
..... _.__....._........ ____
NAME
DAY PHONE (Include area code)
LAKE LA QUINTA HOMEOWNERS ASSC `JACOBUS ARNOLDUS -FRES 760-3=16-1161
STREET ADDRESS
CITY STATE ZIP CODE TR SL LOT
DALLAS TX
MAILING ADDRESS (If different than street address)
CITY STATE ZIP CODE
PO BOX NO: 650858
DALLAS TX 75265-0858
CONTACT NAME AND TITLE
DAY PHONE (Include area code) FAX
TONY
760-265-5685-0000
PAGER (Include area code)
MOBILE (Include area code) E-MAIL ADDRESS
CONSTRUCTION CONTACTS r -
CONTACT NAME AND TITLE
DAY PHONE (Include area code) FAX
PROJECT INFORMATION Attach load data such as pla�raing sheet and dra_wJngs) tiv
F - v .
( PROJECT LOCATION (If different from above)
CITY STATE ZIP CODE TR BL LOT
•47330 CA). hO;BAY
LA QUINTA . .CA, 92253 .
SERVICE DESCRIPTION "
I OOA SERV UPDA`"ING BURNT OUT PANEL
ELECTRICAL INSTALLATION ❑ OH"'" ® UG
AREA/STR.LT QCT; t' n"iNON•CT Q NET METER
❑ 1 PH 3 PH
❑ C-3 VOLTS' 277/460V HP ❑ DIST GEN
TYPE OF CONSTRUCTION O"RESIDENTIAL
E COMMERCIAL'C'INDUSTRIAL .- [:1 SUBDIVISION'
SUBSTATION CIRCUIT. LOAD TOTAL `
- POLE/PAD TOWNSHIP' RANGE � 'SECTION URBAN/RURAL'
.
LA QUINTA N127. : ";
.
_::;UN399b_`.' 5, � . 7- _._ 30 ? • .• . ..URBAN '.
ENGINEERING DATES - K
PROJECT SCHEMILE DATES "
` s Planned Actual
RECD DISTR _ .. ... - e-= t:-.. -:- .
JOB CATEGORY 0
ESTIMATOR
PROJECT START /.0 17
COST ESTIMATE ;'.`'
..,. ,:
PROJECT ENO ..,. .... 17 25/9017
CONDUIT LAYOUT • `
---
A PPROVED
i, L 13 217
ENGR COMPLETE
—
COST APPROVED
DESIGN APPROVED
_
PERSON RESPONSIBLE + DATE APPROVER: 4 r -hop
Mr,=Armando Sandoval
COMMENTS' �._... , r. ... ...... K
i,{. ♦ <
--�
_ .,
IJ � ty
% w s. • h
• t3
t
A(PERIAL iRRIGAIIOY D)Sl'R)Cf
1i+4'FRIAL, CA.
,. S
1.� I
MARCO A. BAUTISTA
fl--
N`
ENGINEERING DISTRIBUTION SUPERVISOR
ng1RE WCE_'�
t
a160DAVE NUE 5e;
p
b4r •• LA QUINTA, CA 42253
SERVICE NOTIFICATiON --4024358 , aP 3023070
10026009,
r
.4rrrt•.a1•aftacuc
SERVICE ORDER -4 6-4 t 6 4., CA
DATE I l; U1 •CITY
APPLICANT INFORMA7701V
NAMEDAY PHONE (incJdde area rade)
LAKE LA QUINTA HOMEOWNERS ASSC .; 760-346-1161
STREET ADDRESS
CITY STATE ZIP CODE TR BL LOT
DALLAS TX
MAILING ADDRESS (!I dlNerent than streeJ.address)
CITY STATE ZIP CODE
PO BOX NO: 650858
DALLAS TX 75267.0555
CONTACT NAME AND TITLE
DAY PHONE (indude area Cade) FAX
TONY
760-265-5685-0000
PAGER (Inc!ude area code)
MOBILE (inc:ude area code) EMAIL ADDRESS
CONSTRUMON CONTACTS
CONTACT NAME AND TITLE
DAY PHONE (Ieuede area code) FAX
PROJECT INFORMATION (Artads lond dais such as plaiinlag sheer aird drawings)
PROJECT LOCATION (If ddfefent from above)
CITY STATE ZIP CODE TR BL LOT
47330 CALEO BAY
LA QUINTA CA 92253
SERVICE DESCRIPTION
IOOA SERV UPDATING BURNT OUT PANEL
ELECTRICAL INSTALLATION OH UG
' ❑ ARENSTR.LT ❑ CT ❑ NON.CT ❑ NET METER'
0 I PH' :. ® 3 PH
C-3 . , VOLTS. 2771480V ; : HP ❑ DIST GEN '
TYPE OF CONSTRUCTION ' 't RESIDENTIAL"
V COMMERCIAL '❑ INDUSTRIAL ❑ SUBDIVISION'
SUBSTATION CIRCUIT LOAD TOTAL
POLEIPAD TOYYNSHiP' RANGE SECTION' URBAN RURAL
LA QUINTA___:. .�N127 _.
UN3996 ... _ _, ,..5, 7 ::: _ _.. :30 ..... URg6
ENGINEERING DATES
PROJECT SCHED ULE DATES
Planned Actual
RECD OISTR >..... _ .
JOB
ESTIMATOR...- :.
c:
PROJECT START,. `. . ' : >: -1.12 17
COST ESTIMATE
-
PROJECT END
CONDUIT LAYOUT
E D
rUL�l 20t7 3
ENGR COMPLETE
COST APPROVED
DESIGN
_
CU$t0-0:r Operations - LQ
t? 7a�lro X1V,ru'+ 'P
Date Recd By
Rcrbca W212W _
01, la Q=to Afeu:r tab %h p -
Commerclal Electric Metering Anproval Dorm
Customer Service proposal#.
IID to Fill Out
�� �' haarr Dnw'Inet U Approved Rejected By
Alacr bwshq . Date:
1tnF-eeleerrhmROM AICJ ache i :Approved 0 Rejected By: ,- Date:
Number orcebles Por Plisse- ��........
."�
- ..::. And
Transformer -t' Fad Mount f Moli Mount Size: KVA
IID Cantact Name: Phone No:
f�..w�ww.�r �A...1 Clrl f1..• I�___e_._._. .
Customer Contact Name:
amePhone No:
Electrician Contact Name ahiA�f Phonc No :. -7C,6
Name of the Frojeet Jjc y _ . _
Location. Address of Project 7 „r`A le
(County ICity Approved) '
Panel Manufacturer:
VOLTAGE: L 208YI120V 3PH 4W H 12024QV I P113 1! 240I120V 3PH 4W ,.,.
:480 Z7 . �P1� 4W see w,k t raoonn,� nw w �pe�tusY owe r
n A -
MAINS RATED:' AMPERES . E D
BUSS MATERIAL: Pd'ALUMijMM(STD.) [l COPPER 13 2017
BUSS CROSS SECTIONAL AREA BASED ON: [JUL
❑ 1000 AMPS PER SQUARE WCH (COPPER) By: LO Metej Shop
750 AMPS PER SQUARE 1NCFI (ALUMINUM) 9o2y 3y D '
METEMG PROVISIONS:,,, i °"� // 4135,
)I C— CQMPT.'400=-1000A [; 3P.FI 4W ERC -12 '-i--JAli 31V QSERC 319
❑ CT COM'.PT. 1001--�3000A b 3P1 f 4 W EUSERC 322 • ` ` :: `
❑ CT COW— T. 3001A + I7 3PH 4W EUSERC 324
METER DOOR:JEUSER�3L2 15' DOORS 1'I MULTI—METER
ENCLOSURE TYPE: t 'NEMA 1 ij(NrzwJR 0 OTHER
-NCOMING TEED 0. TOP,V BOTTOM SECTION No
bfCa�SERVICE; usERC #'S
q345 o 1i7, REr. a OH SERVICE.
SHORT CIRCUIT CURRENT RATING. -',t. - RMS SYMMETRICAL.,
upuoost
OUTGOING FEEDERS EXIT: U BOTTOM U TOP
UL SERVICE ENTRANCE LABEL: o YES L NO
0 FIMSH--ANSI
CONSTRUCTION TO COMPLY WITH THE LATEST ANSI. NEMA UL AND ALI.
APPLICABILE INDUSTRY STANDARDS, EQUIPMENT TO BEAR THF UL LABEL F'
YES n NO 0 OTHER REAR ACCESSIBILITY AVAILABLE n YES ri NO
SIDE ACCESSIBILrfY: 0 LEFT n RIGHT 0 BOTH n NO
For any questions calf your Proiect Marmr er Cartes Partidu 398-5820 or 275-8502 Carlos Puente 398•
5137 or 275-31 Il Travis 1l1aston 398.3871 or 275-3635 Rasalinda 6seobedn 398,5811 of 275-3310
VESJGMATIZNM'A
a
SUB FEED
PROVISION
MAMC
HFXD6
12MP
6.75 Deep 20.0
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SLCTM
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64AN009Wbo UL
18A Alen Owt CANNaw
APPROVED
JUL 13 2017
By L
9�29358/4o//p�3¢
PEDESTAL REPLACEMENT
. ownwo-1
CFAWWbf [Slarnwa Induafty, Inc,
Meter Socket / Enclosure Combination Cabinets
CT Rated
U172D13)elosed)
AppGaatian
• Removable l2sl smidl peldt inc uded
• I•cludes prarsmns 10 MSIAII modeF 6019/6067 CT rr`v7 yh
• Rece.va AN51 012.10 ,f aahout rrtotars
• t3recread andror undergound feed (see drag;
• 5utlace m0mr1
Can-te ttian
• fLng type
• NEMAType 3R
• ANSI 61 gray E -coat (mhslt
• Alum num snap ring mrJuded
Standards
• UL alt Luted
- ANSI C12.7
• EUSEI+C 313
• EUSERC314
E
JUL 13 2017
l _ By: LD Meter Shop
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114-110
114.110
114-110
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gills
20
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114.810
114.810
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ILL, — —• {
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CT SECTION
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