BELC2017-0006�a w.
78-495 CALLE TAMPICO 4 � U
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2017-0006,
Property Address: 50660 EISENHOWER DR BLDG 32
APN: 773370028
Application Description: SILVER HAWK APARTMENTS / PANEL CHANGE OUT
Property Zoning:
Application Valuation: $2,200.00
Applicant:
CALIFORNIA WIDE ELECTRIC
24594 SUNNY MEAD BLVD STE Y
MORENO VALLEY, CA 92553
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the'Business and Professions Code,
and my License is in full force and effect.'
License Class: C10 License No.: 9972.73
Date 6 3 ` %Zo /1 Contractf,6 1/ `�e�✓� . U �� A,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the—
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a,
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($Soo).:
(_) 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/31/2017
Owner:
LANDS
3366 VIA LIDO
NEWPORT BEACH CA 92253
Contractor:
CALIFORNIA WIDE ELECTRIC
24594 SUNNY MEAD BLVD STE Y
MORENO VALLEY,CA 92553
(844)225-9433
Llc. No.: 997273
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of :he following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3100 Df the Labor Code, for the performance
of th ork for which this permit is issued.
_73--l-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: HARTFORD ACCIDENT & INDEMNITY CaMPANY Policy Number:
I certify that in the performance of t&e 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 37D0 of the Labo Code, I shall forthwith
comply with those provisions.
D: It's Z o Applican�,
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 ACKNOW4EDGEMENT
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 applical[ion is made; each person at whose
request and for whose benefit work is performe j 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 Cty 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 applica5on becomes null and void if work is
not commenced within 180 days from date of is: uance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and stat-_ 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 up�n the
11
above-mentioned property for inspection purpo_.es. n
Dat' e'/ 26i� Signature (Applicant of Aget)ll�z
Owner:
LANDS'
3366 VIA LIDO
NEWPORT BEACH. CA 92253
Date: 1/31/2017
Applicant: Contractor:
CALIFORNIA WIDE ELECTRIC CALIFORNIA WIDE ELECTRIC
24594 SUNNY MEAD BLVD STE Y 24594 SUNNY MEAD BLVD STE Y
MORENO VALLEY, CA 92553 MORENO VALLEY,.CA 92553
(844)225-9433
Lic. No.: 997273
----------------------------------------------------------------------------------------------
Detail: ELECTRICAL- CHANGE OUT (1) PANEL. 2016 CALIFORNIA BUILDING CODES.
Application Number:
BELC2017-0006
Property Address:
50660 EISENHOWER DR BLDG 32
APN:
773370028
Application Description:
SILVER HAWK APARTMENTS/ PANEL CHANGE OUT
Property Zoning:
Application Valuation:
$2,200.00
Owner:
LANDS'
3366 VIA LIDO
NEWPORT BEACH. CA 92253
Date: 1/31/2017
Applicant: Contractor:
CALIFORNIA WIDE ELECTRIC CALIFORNIA WIDE ELECTRIC
24594 SUNNY MEAD BLVD STE Y 24594 SUNNY MEAD BLVD STE Y
MORENO VALLEY, CA 92553 MORENO VALLEY,.CA 92553
(844)225-9433
Lic. No.: 997273
----------------------------------------------------------------------------------------------
Detail: ELECTRICAL- CHANGE OUT (1) PANEL. 2016 CALIFORNIA BUILDING CODES.
Z;l
INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101=0000-20306 0 $1.00'.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600.
0
$12.67
Total Paid for ELECTF ICAL• $38.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
Y.
Bin #
City of b Quin to
Building 8t Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Slwet
Project Address: / /5 Owner's Name: <
8f aw / .1.
A. P. Number:
Address: 6`0
Legal Description: �� Q 6-11 .1 �l? 1. �` r 1 i City, ST, Zip: L� uJ A, �ZZS3
Contractor: ' Telephone:
o i N i cif : L.
Address:S
vNM
1' sv". L Project Description: oUt42 '
City_ ST, Zip: M
Telephone: le h
P - � 3
Y 3
State Lic. # : 5 Q-4LL
Arch.,•Engr., Designer:
City Lic: #.:
t
Address:
J
City, ST, Zip:
Telephone.
h one:
State to Lic. #
Name of Contact Person: S "
Occupancy: n/
Construction Type: G �
I r Ra
mo type (circle one): New Add'nA_oJect
r De
k.6 134 -t- Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person:
7 / � YV Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
ff
Submittal
Req'd
Reed
TRACKING
PELMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural CACS.
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 Deed
Plans picked up
S.M.C.
II.O.A. Approval
Plans resubmitted
Grading
1N ROUSE:-
'''. Review, ready for corrections/issue
Developer Impact Free
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
Source
Seller Reference Number
Release Number
Eaton Corporation Order Packing Slip
W87
LAJB03171
5316019
Eaton Corporation
Order Date
Purchase Order Number
Page Number
13201 Dahlia Street •
YYYY-MM-DD
Fontana, CA 92337
2017-01-30
6435-JA937229D
1 of 1
Ship To:
Sold to:
Any carrier/freight claim issues, please do the following:
CED RIVERSIDE CA 6435
CED RIVERSIDE CA 6435
Sign and receive all material.
Note issues on carrier receipt.
1601 IOWA AVENUE
P 0 BOX 5406
LTL: 1-800-706-5640
s@expeditors.com
RIVERSIDE
RIVERSIDE
Parcel: 1-800-'41g0-2910
CA 92507 US
CA 925175406 US
Email: corerg?eaton.com
Special Markings/Instructions: ----
Shipping Point
Via
Tracking No.
Shipment No.
Date Shipped
Freight Terms
YYYY-MM-DD
Fontana, CA
WCAL
101979093
2017-01-30
Will Call
Customer
Eaton
Product ID
Style Number
UPC Item :
Serial
Qty
Qty
Qty
Line No.
Line No
& Description
Count
Ordered
Shipped
JOM
Catalog Number
Serial Number
1
1
1MFS600RUG
IMFS600RUG
78T849053734
1
1
EA
MAIN SERVICE MODULE, 600A 1 PH
LMFS600RUG
2
2
1MM512R
86849051914
1
1
EA
1 PHASE RING M.M., 5 SOCKETS,
51IMM512R
3
3
1MM412R4
J. V412R
IMM
786849051907
1
1
EA
1 PHASE RING M.M., 4 SOCKETS,
4
4
3MMBSK
3MMBSK
786849054052
1
1
EA
BUSSED SPACER FOR STACKS, 1200
3MMBSK
5
5
1MWB
1MMWB
786849054243
1
1
EA
MkLL MOUNTING RAIL FOR STACKS,
MMWB
Weight
Received By
Date Received
Received Total ---->
31 .85