BSPN2018-000278-495 CALLS TAMP..ICO D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/25/2018
Permit Type/Subtype: SPECIAL INSPECTION/ Owner:
Application Number: BSPN2018-0002 SUNRISE LA QUINTA CO
Property Address: 54.092 OAK TREE .75005 COUNTRY CLUB DR
APN: 775081021 PALM DESERT, CA 92253
Application Description: PGA WEST / POOL HOUSE / MAIN BREAKER CHANGEOUT
Property Zoning:
Application Valuation: $400.00
Applicant: Contractor:
GRAYCO ELECTRIC INC jJ (r1]_.� GRAYCO ELECTRIC INC
P 0 BOX 13311 - P 0 -BOX 13311
PALM DESERT, CA 92255 `IA �i 94 2o18 PALM DESERT, CA 92255
ICOMMUNITYp DFIiQVINTA (760)250-0467
��ECOPMENTDFPeon,�.._ LIC. No.: 977951
LICENSEDCONTRACTOR'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.: 977951
Date: Contractoiw
OWNER BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the ntractor'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).:
LJ 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.).
(J 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:
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 tbg work for which this permit is issued..
A� "ave and will maintain workers' compensation insurance, as required by
Se ion J 00 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 FARM FIRE AND CASUALTY COMPANY Policy Number: 9000E2646
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.
- Py
Date: Appy
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION RA S UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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-
mentioned property for inspection purposes.
DatJ Signatuce.(Applicant or Agen
Date: 1/25/2018
Application Number:
BSPN2018-0002
Owner:
Property Address:
'`'54092 OAK TREE
SUNRISE LA QUINTA CO
APN:
775081021,
75005 COUNTRY CLUB DR
Application Description:
PGA WEST / POOL HOUSE / MAIN BREAKER CHANGEOUT
PALM DESERT, CA 92253
Property Zoning:
Application Valuation:
$400.00 .
Applicant:
Contractor:
GRAYCO ELECTRIC INC
GRAYCO ELECTRIC INC
P O BOX 13311
P 0 BOX 13311
PALM DESERT, CA 92255
PALM DESERT, CA 92255
(760)250-0467
-------------------.-------------------------------------------------------------------------
Llc. No.: 977951
Detail: SPECIAL INSPECTION
FOR (1) MAIN BREAKER CHANGEOUT. THIS PERMIT DOES NOT INCLUDE
ANY OTHER ELECTRICAL WORK OR RELOCATION OF
' EQUIPMENT. PER 2016 CALIFORNIA ELECTRICAL CODE
,DESCRIPTION.
FINANCIAL INFORMATION
ACCOUNTQTY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$78.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0.
$5.00
Bin.#
. itY. of La QUhl ta
Bullding a Safety Division
P.O. Box 1504,76-495 Calle Tampico
IA.Quinta, CA 92253 -:(760) 777-7012
404W4,Building Permit' Application and Tracking Sheet
Permit #
Project -Address: 09.2 t?4Kic G.Q
Owner's Name:. P�4 it'f �Lu�rS6�ts%fAL - aC
A P. Number.
Address: ;S'y,320 So tER.✓ 'y/mss
Legal Description:
City, ST, Zip: v/:✓ s�i4 Ci9 922 Sir
Contractor -.4G �.✓L.
Telephone 46 7-7/- /2-r c/ r !
Address: "? /�� /�3 /
ProjectDescription: X,*��-j
City, $T, Zip: P l�„j C/9 9225
il�A/N %Z
Telephone: 7100 21,40--639
State Lic. # : CIO 977 9s/
City Lic. fl;
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone:
State Lia #:r �' ""
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair• Demo
Sq. Ft.; #StoriesUniv:
Telephone # of Contact Person: 7 ZSQ 3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
ti
Submittal
Req'd
Reed
TRACKING
PERMIFF'EES-
Plan Sets
Plan.Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance -
Title 24 Calm
Plans picked up
Construction
Flood plain plan
Plans resubmitted •
Mechanical
Grading pian
2•" Review, ready for correctionsrmue
Electrical
Subeoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans plcked up
S.Md
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
aid Revlew, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Coiled Contact Person
AXP -P -
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
j ..
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