05-4552 (ELEC)79705 Arnold Palmer
IIIIIIIIIIIIIIIIIIIIIIIII 26
IE
P.O. BOX 1504 T4ht 4 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: 10/11/05
Application Number: 05-0000455.2 Owner:
Property Address: 79705 ARNOLD PALMER KEATING WALTER
APN: 775-241-040- - - 79705 ARNOLD PALMER
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 300
Con r S'
Applicant: Architect or Engineer: o L ECTRIC INC.
D 423 NGTON ST, STE F#381
1 16DE0-094 CA 92211
OOC y L' o. : 75466
-------- ---- -- ------------- - ------ --- ----- -- - ----- ----- - -- -------- ---- --------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with ereby affirm under penalty of perjury one of the following declarations: -
Section 7000)of Division 3 of the Business and Professionals 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: C10 license No.: 275466 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
Date: Contractor: _ I 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
OWNER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0009629
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to 1 certify that,in the performance of the work for which this permit is issued,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any manner so as to become subject 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 beco a subject to the workers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 00 of the La r Code, al or hwith co I with those provisions.
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).: e: I pplicant:
(_1 1,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: FAILURE TO SECURE WORKERS'COMPENSATION CIDER E 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 PENALTIES AND CIVIL FIN S U 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 COST OF COMPENSA ,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.). APPLICANT ACKNOWLEDGEMENT
( ) 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;
( 1 I am exempt under Sec. ,BAP.C.for this reason 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
/L ts performed under or following issuance of this permit.
Date: l — ner: 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 AGENY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agent r the performance of the I certify that I have read this application and statethat the abov information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and co my ordinances ands a laws relating to building c str ction,and hereby authorize representatives
of th' my Jo enter upon a above-mentioned prope or' ction peasest
Lender's Name:
i) 7Fate: ignature(Applicant or Ag t):
Lender's Address:
LQPERMIT
Application Number . . . . . 05-00004552
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 18.75 Plan Check Fee 4.69
Issue Date Valuation . . . . 0
Expiration Date 4/09/06
Qty Unit Charge Per Extension
BASE FEE 15.00
5.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 3.75
----------------------------------------------------------------------------
Special Notes and Comments
ELECTRIC LINE TO BBQ - 5 OUTLETS
Fee summary. Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 18.75 .00 .00 18.75
Plan Check Total 4.69 .00 .00 4.69
Grand Total 23.44 .00 .00 23.44
LQPERMIT
Bin #
City of La Quinta
Building& Safety Division
Permit# P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address 70,�—) Owner's Name: &AQ6�e
a
L Number:
Address: / � /?Os- 14� d
Legal Description: City,ST,Zip: L
Contractor: Ap, p
Tele hone:
Address: Project Description:
City,ST,Zip: G C-7'54*L eem�,t IitJ I rl�
Telephone:
State Lic.# : City Lic.#:
Arch.,Engr.,Designer:
Address:
City,ST,Zip:
Telephone: Construction Type: Occupancy:
State Lic.#: Project type(circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq.Ft.: #Stories: #Units:
Telephone#of Contact Person: Estimated Value of Project ,
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd 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 Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted Mechanical
Grading plan 2"d 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:- 3rd 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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NG &SAFETY DEPT. �(> (� 1
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OFT78-495 CALLE TAMPICO— LA QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012 FAX (760) 777-7011
OWNERBUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder"you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself,you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
-If you are an employer,you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with
resp-ct to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees,without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760 777-7011
OWNER'S SIGNATU ATE
71- ?D 5
PROPERTY ADDRESS
PERMIT NUMBER(S)