BELC2018-00114 78-495 CALLE TAMPICO VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/ Owner:
Application Number:. BELC2018-0011EL POLLO LOCO
Property Address: 78(pa ( "(Cih,a AY 1
APN:
Application Description: EL POLLO LOCO / TEMP POWER. .
Property Zoning:
Application Valuation: $1,000.00
Applicant: JAN Contractor:
M D M CONSTRUCTION INC M D M CONSTRUCTION INC
4212 E LOS ANGELES AVE 3421 4212 E LOS ANGELES AVE 3421
SIMI VALLEY, CA 93063 LA QuiNTA SIMI VALLEY, CA 93063
DEPARTMENT .
(818)332-6517
Llc. No.: 629030
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: B License No.: 629030 /
Date: _/A/ 1 � Contractor: 74/N1C I)AJA 7iiu. ®,. 11A.4 I)AA
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).:
(1 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
i
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
Lender's Address:
Date: 1/31/2018
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.
WI 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: STATE COMPENSATION INSURANCE FUND Policy Number: 1718892
_ 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.with those provisions. B
Date: Applicant: �j�LS 4 4y"t G
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 Quintal* 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-
mentioned property for inspection purposes. .
Dater S / % Signature (Applicant or Agent):
�.
Date: 1/31/2018
Application Number: BELC2018-0011
Owner:
Property Address:
EL POLLO LOCO
APN:
Application Description: EL POLLO LOCO / TEMP POWER
Property Zoning:
Application Valuation: $1,000.00
Applicant:
Contractor:
M D M CONSTRUCTION INC
M D M CONSTRUCTION INC
4212 E LOS ANGELES AVE 3421
4212 E LOS ANGELES AVE 3421
SIMI VALLEY, CA 93063
SIMI VALLEY; CA 93063
(818)332-6517 "
Llc. No.: 629030
Detail: INSTALL TEMP POWER POLE 200 AMP 120/208V
Contractor Name:
WA
............ C:E\4' nfrir. 1':)TS,StiR:T• .— .............
Address:
PERMIT #' A�L C ZoI. ®Q I
PLAN LOCATION: _
Project Address: 7 1
City, St, Zip `
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Telephone:
17
Patio/Porch
—
Email: AA QM A,)Fire
Sprinklers
SF
State Lic: ity Bus Lic:
Applicant Name:
1
Address:
3zfZl
City, ST, Zip:
J
Telephone:
Z
Email• -]
.l� WA I
Valuation of Project $
Contractor Name:
WA
New SFD Construction:
Address:
Address: Aik_ —
/ I
412t.
Conditioned Space
SF
City, St, Zip `
Garage
SF.
Telephone:
17
Patio/Porch
SF
Email: AA QM A,)Fire
Sprinklers
SF
State Lic: ity Bus Lic:
W
Arch/Eng Name:
Construction Type: Occ pancy:
Address:
Grading: !
City, St, Zip
Construction Type: Occupancy:
Telephone:.
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial /Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
1
' Submittal.
Req'd
'Rec'd
r-
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs ,
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
'
1
Grant Deed
HOA Approval
4
School Fees
•Burtec Debris Plan
Planning approval .
r
Public Works approval
Fire approval
City Business License
1
r-
1000A
120/208V,-
30 '
90
/ 44
S
O
UN111,2425P
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1~
CONTRACTOR/DEVELOPER - _ •�
ti
s •
IN -N -OUT
120/208V f�
30
'3525'YT �'.
`UN 121`5P
. r I
CUSTOMER: "I
y ( T.O'REMOVE•EX. XFMR PAD COMPLETE: ' 6770.
,95' ; �y� w r A DPG
12 •
Sr;, , " .'' ,• ` '�.. \ _ ,.l'J`N 1222307P .
f EXISTING ENERGIZED CND. W/'3-1 /0 ACN PRI CA. ,f `
120
�3 310'
105 .`� `' <�' M R 25
44 ���.�\f� 0 0 8V P� f
r�
�-
30
3 '
RETAIL SHELL
1v 255'
xsee
` , 25
Id
U NI O
85-86 o�J�
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LQ
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'UN1222401SCr
NOTE: EXISTING VEGETATION TO BE RELOCATED/REMOVED
FOR PROPOSED UNDERGROUND SECTOR CABINET INSTALLATION. 10'
25
p
CAUTION: EXISTING ENERGIZED CND. W/ 1 /0 ACN PR
CUSTOMER TO:INTERCEPT AND REROUTE EXIS
2-5" PRI. CONDUITS"TO NEW SECTOR UN1222309SC
U N 1112426.
135'
I N-! 093633S
Cpll: TOLL FREE
1-800
422'4133
✓' TWO WORKING DAYS
BEFORE -YOU DIG
100
44
CONDUIT NOTES:
1) F�l SECONDARY RUNS SHALL BE INSTALLED
AT A DEPTH OF 30" MIN. USE DETAIL'C' ON
SEE SHEET 45.
12 INSTALL 1-2" CND. PER SHOWN LENGTH.
SEE DETAIL SHEET 25.
44 INSTALL 4-4" CND. PER SHOWN LENGTH.
SEE DETAIL SHEET 25.
25 ET INSTALL 2-5" CND. PER SHOWN LENGTH.
SEE DETAIL SHE25.
TRENCHING. NOTES:
TYPICAL: CONTRACTOR SHALL INSTALL
2" LINE GUARD TAPE (RED)
"CAUTION: BURIED ELECTRIC LINE BELOW."
SEE SHEET 49.
TYPICAL: 7FROM FACE OF CURB
TO CENTER OF TRENCH.
UNLESS OTHERWISE NOTED.
SEE DETAIL SHEET 46.
CURVE DATA TABLE
#
RADIUS
<
LENGTH
R1
12.5'
52°
11.27'
R2
12.5'
41-
9.01'
R3
25.0'
49°
21.39'
R4
50.0'
90°
78.53'
DETAIL SHEETS:
DETAIL SHEETS REFER TO THE DEVELOPERS ENERGY
PLANNING GUIDE(D.E:P.G.) REV. 4.3 2010, IT CAN BE
OBTAINED ON THE IID WEB SITE WWW.IID.COM
DETAIL KEY:
Qii-DETAIL PAGE
-DEVELOPERS ENERGY
PLANNING GUIDE
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
BY
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VICINITY MAP
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410
1 25' 50' . 10
womlill
SCALE: 1"=50'
T.5, R.7, Sec.30
CIRCUIT: 4005
N. LA QUINTA SUB.
-1 FERVICE NOTIFICATION: 4018198 SERVICE ORDER: 60094386 SHEET 1 OF 1
TOTAL CONSTRUCTION HOURS REVISION CHART IMPERIAL IRRIGATION DISTRIC'.
DA iE: REV. BY: DESCRIP110N IMPERIAI, CA
COACHED VALLEY DIVISION
X A UNDERGROUND DISTRIBUTION
Supy, WORK ORDFR CONT.for
DISTRIBUTION PLANNER WARR ACM LA QLTIN Y Ili B LLC
78611 X vowER LA GOND Alf CA LAYOUT92253