11-0134 (ELEC) ceiliii, 4 44,4,44.,4
4
P.O. BOX 1504 VOICE(760) 777-7012
78-495 CALLE TAMPICO FAX(760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/08/11
Application Number: 11-00000134 Owner:
Property Address: 52867 HUMBOLDT BLVD EAST OF MADISON LLC
APN: 767-880-012- - - PO BOX 1482
Application description: ELECTRICAL LA QUINTA, CA 92247
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500
Contractor:
Applicant: Architect or Engineer: DBCA INC 1 ,1 n ��l
P.O. BOX 1482 �I rr�1 J
LA QUINTA, CA 92247 !1-1
�.....r 1
i
(760)393-5271 �_. t I
r�l Nil IL;
A
LiC. No. : 915336 I ` J f Ci7YOFLAQUiNTA
�!:.. -. :E.T)1PT.
UCENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a •.nsed nder provisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000)of Division 3 of the Business and- •fessl.na Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
License Class: B Lice ,No.: 915336 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
If issued.
I
P B•i•f tractor: 1f� _ 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
❑•i NER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am ,�empt from the Contractor's State License Law for the Carrier TRAVELERS PROP Policy Number YEUB282D779708 _
following reason(Sec.7031.5,Business and Prof:i sions Code: Any city or county that requires a permit to _ I certify that,in the performance f re work for which this permit is issued,I shall not employ any
construct,alter,improve,demolish,or repair any ucture,prior to its issuance,also requires the applicant for the person in any manner so as to a •me s .•act to the workers'compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should bac =subja.t to :workers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the Labor Code,I she f. h.- comply, h those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by /// ��I .0�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: /Date• Ap •,� �U`
(_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 WARNING: PAILU5E40 SECURE WORKERS'COI,' NSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTI�:AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE C++ OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
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.). APPUCANT ACKNOWLEDGEMENT
I I I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,each agrees to,and shall defend,indemnify and hold harmless the City
of La Ouinta,its officers,agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above I I., atlon is • - I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to building con-r 1 tiara,an; hereby a once representatives
of this county to enter upon the above-mentioned property for Ins.el ses
Lender's Name: — �J p .
1 1c. pate:!J O. rgnature(Applicant or Ages : "�[--
WIP
Lender's Address: — �{' ///
LQPERMIT
Application Number 11-00000134
Permit ELEC-SERVICE CHANGE
Additional desc .
Permit Fee . . . 33.50 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 8/07/11
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
100 AMP ELECTRICAL SERVICE FOE COMMON
AREA, TRASH BUILDING, YARD LIGHTS FOR
LOTS 8-11, AND FOUNTAIN. 2010 CODES.
Other Fees BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
Permit Fee Total 33.50 .00 .00 33.50
Plan Check Total .00 .00 .00 .00
Other Fee Total 1.00 .00 .00 1.00
Grand Total 34.50 .00 .00 34.50
LQPERMIT
Bin# MIDkSoi u City of La Quinta
Building 8t Safety Division
Permit# P.O. Box 1504, 78-495 Calle Tampico
/ 1(� La Quinta,CA 92253- (760) 777-7012
\` J Building Permit Application and Tracking Sheet
Project Address: kf:Oc.4:;--„!1'r C� Owner's Name: /47
A.P.Number: 7 - ei o-Otte Of, OCa OS Address: 52 7' #Z . 52. x
y Legal Description: City,ST,Zip: a Q „,74 9'Z T3 '(
Contractor: :W:M •-:'•
Tele hone: < ' S "-`It'
VX I�� OGI �jri cotes G� p ) �! 3 -.- .. . :
Address: 6/[ ,� , �� Q Project Description:
' M City,ST,Zip: G� QU1XJ7�1 Of {2Z53 ��p�lt. c-2+�-'0..c.4, tot)!'r;�-t :Z:`2.
felephonc' (L 3 _,.,yew,, ' '- % : Cc:-.A. •o_k1) ,Qb....--r S0 (=ILE,' t wet:,
X L]
_State Lic.#: City Lic.#: j v,'k irk , %\ — ( .o Oe r . ,i�
- 1 E
Arch.,Engr.,Designer: LAtet 6 I Cc,s,,`) kV
Address: 'r
City,ST,Zip: -(.-_A'— ta- - b u
p ' ma's;;;* >--: ,:-.rc--' Construction Type: Occupancy:
Telephone: �- ,<;
•;ej -,,, ;, mot-;:='<
State Lic.#: ;,<,.;,;N;;,,,,;;a,�-;-,,;;;�.' �;�;���; Project type(circle one): New Add'n Alter Repair Demo
...11 1 Pc re1/4:0ST
y. Name of Contact Person: _ u .. c� i N s�( Sq.Ft.: c.N 9 ', #Stories: k #Units:
Y
, F 9� --118_3
Telephone#of Contact Persons,G -� �CvoZ—- p;. —y�7_Z Estimated Value of Project: 5
APPLICANT: DO NOT WRITE BELOW THIS LINE
I
# 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
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.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
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