BELC2019-000378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GRAYCO ELECTRIC INC
P 0 BOX 13311
PALM DESERT, CA 92255
`cur 414P Qa4a
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
ELECTRICAL/
BELC2019-0003
51910 AVENIDA RUBIO
773162008
HAMLETT / 200A ELECTRICAL SERVICE CHANGE OUT
$1, 500.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DORA HAMLETT
51910 AVENIDA RUBIO
LA QUINTA, CA 92253
�Q� � Contractor:
DLI--=-L�e GRAYCO ELECTRIC INC
DP 0 BOX 13311
JAN 10 2019 PALM DESERT, CA92255
CITY OF LAQUINTA (760)250-0467
Llc. No.: 977951
DESIGN & DEVELOPMENT DEPARTMENT
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 a Business and Professions Code,
and my License is in full force and effect.
License Class:
/C;10 �f License No.: 77951
Date: _ G -� 1 Contractor:
OWNER -BUILDER DECLARA O
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:
Date: 1/10/2019
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'
'Comps tio"as provided for by Section 3700 of the Labor Code, For the performance
of th ark for which this permit is Issued.
have and will maintain workers' compensation insurance, as required by
Sec ion 3 of the Labor Cade, for the performance of the work for which this permit
Is issue . My workers' compensation insurance carrier and policy number are:
Carrier: STATE FARM FIRE AND CASUALTY COMPANY Policy 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 beaAe subject to the workers'
compensation laws of California, and agree that,�theLabor
uld become subject to the
workers' compensation provisions of Section 370 Code, I shall forthwith
comply with those provisions.
Date: /_ / Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C60ERAGE 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 r ing to building
construction, and hereby authorize representatives of this city to
upon the
above -mentioned property for inspection purposes.
Date: / / Signature (Applicant or Agent):
Lender's Address:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
GRAYCO ELECTRIC INC
P 0 BOX 13311
PALM DESERT, CA 92255
BELC2019-0003
51910 AVENIDA RUBIO
773162008
HAMLETT/ 200A ELECTRICAL SERVICE CHANGE OUT
$1,500.00
Owner:
DORA HAMLETT
51910 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
GRAYCO ELECTRIC INC
P 0 BOX 13311
PALM DESERT, CA 92255
(760)250-0467
Llc. No.: 977951
Date: 1710/2019
Detail: 200A ELECTRICAL SERVICE CHANGE OUT (200A EXISTING] THIS PERMIT DOES NOT INCLUDE RELOCATION OF EQUIPMENT. 2016 CALIFORNIA
BUILDING CODES.
T t I P M f BUILDING STANDARDS ADMINISTRATION BSA
o a ai or $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SERVICES
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SERVICES PC
101-0000-42600
0
$13.34
Total Paid for ELECTRICAL: $40.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION I ACCOUNT I QTY I AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
q a 0
-----� GEM ofib, DESERT ---
PERMIT #-F-)ELIC- zO19' — o oo 3
PLAN LOCATION:
Project Address: 51110 R
SProject Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Applicant Name: &YMLI co r o
Address: 775-50 I&hC�(,� '(�F-I
'�,
City, ST, Zip: Pr. m Bl��v 7211
Telephone:
Email: W4 e d��%
Valuation of Project $
Contractor Name:
t° �G I y�
New SFD Construction:
Address: "7 ? �?�
i
Conditioned Space SF
City, St, Zip -PG t44
�ev 1
Garage SF
Telephone: D
_ -/
Patio/Porch SF
Email: ��
rA cc - E eCA/
F#re prSri ers ST
State Lie: f771&
City Bus Lie: 9- R
Lll
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lie: City Bus Lie. -
Property Owner's Name:
Q�/�
New Commercial / Tenant Improvements:
Address: to' all
Total Building SGO SF
City, ST, Zip y!
Construction Type: Occupancy:
Telephone:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
Req'd
Plan Sets
Structural Cates
Truss Cates
Title 24 Cates
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Btmiiiess License
Ca DIR #1000023661
CSLB #977951
P.O. Box 13311
Palm Desert, Ca 92255
Name I Address
Dorai ilton 4p.6-1
51910 Avenida Rubio
La Quinta, Ca 92253
Estimate
Date
Estimate #
9/26/2018
1260
Phone #
760-250-0467
Project
Panel Change
Description
aty
Cost
Total
Site:
51910 Avenida Rubio
La Quinta, Ca 92253
Panel Change:
Obtain City of La Quinta permits.
Schedule IID inspection if required.
Demo out old 200 amp Zinsco overhead fed main panel.
Install new 200amp Square D overhead fed recessed mount panel.
Tie in all existing circuits to new panel.
Ensure adequate bonding and grounding per city spec's
Note:
-Power will be down to house for a minimum of 8 hrs possibly 24 hrs.
Excludes:
Stucco repair and paint.
Smoke and CO2 detectors.
Any item not listed in above scope.
Total
Customer Signature