0800001774 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00001774
Property Address:
80171 PALM CIRCLE DR
APN:
649-090-023-12 -4518 -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3500
Tiht °F 4-Qumrw
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------------------------------
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 Prn ionals Code, and my License is in full force and effect.
License Class: C10 icense No.: 881356
/ate( r'' Contractor: .�, 'v
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of ped r 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
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: _
Lender's Address:
LQPERMIT
Owner:
WESTWARD ISLE HOA
80171 PALM CIRCLE
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/29/08
DRIVE
LA QUINTA, CA 92253
Contractor:
NAVARRO, ANTHONY
75455 WILD FLOWER LAN
PALM DESERT, CA 92211
(760)568-6583
Lic. No.: 881356
------------------
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.
_ 1 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 NAVIGATORS INC Policy Number WSATMECO0292001
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner se as to become subject to the workers' compensation laws of California,
and agree that, if I should ome sub- m to the rker ' compensation provisions of Section
3700 of the Labor Code all fo iiI, camp) it
ase provisions.
11' f%a licant:
WARNING: FAIL nETO CURE WORKERS' CO ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL E 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 Director of Building and Safety 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 ngr a to comply with all
city andyounty ordinances/nd state laws relating to building tructiv and hereby out !ze representatives
of [h- puntpy to en er u n the above-mentioned property ins purposes. �}
ate; ��G d+ Signature (Applicant or Agent): 7
Application Number . . . . . 08-00001774
Permit . . . ELEC-SERVICE CHANGE
Additional desc _
Permit Fee . . . 33.50
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date 4/27/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 18.5000 EA ELEC SVC
<=600V/<=200A
18.50
------------------------------------------------------------------...
Special Notes and Comments
.._..-
REPLACE COMMON AREA 100 AMP PEDESTAL
(SERVES POOL, IRRIGATION & LANDSCAPE
LIGHTING)
Fee summary Charged Paid Credited
Due
Permit Fee Total 33.50
.00
.00
33.50
Plan Check Total .00
.00
.00
.00
Grand Total 33.50
.00
.00
33.50
LQPERMIT
MF
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 1�
Project Address: 060—
1-71
Owner's NamelkteS7�af� isle
TRACKING PERMIT FEES
A. P. Number:
Plan Sets
Address:
Legal Description:
Contractor: 4 ' C
1f C I (�C
City, ST, Zip:
Telephone: 1'' w��'�'` '
P -r�
Address: �5y55
n
Project Description:
City, ST, Zi fp lM
�7 r� C� ? Z l (
CI C SZ Co rvi flit o.AJ
Telephon : 7%O sfo p — �ps
r
i4 +Cr eJ A S4.4 l o0
State Lic_ # : '915 L3
Arch., Engr., Designer:
5( -v City Lic. #:�f-a&',�rE»
V25 P�aC rr
L
Address:
Plans picked up Construction
City, ST, Zip:
Flood plain plan
Telephone:
Plans resubmitted Mechanical
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Subcontactor List
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
op
Estimated Value of Project: -3 5Q�
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Energy Cales.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2nd Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"' Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
THIS MAP /S FOR
+ ASSESSMENT PURPOSES ONLY
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