06-0844 (ELEC) 111111111111111111111111102 -�
P.O. BOX 1504 IE 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: 3/01/06
Application Number: 06-00000844 Owner:
Property Address: 80957 CALLEJAZUL LOT H PUERTA AZUL PARTNERS
APN: 762-240-003-H -300961- 17700 SW UPPER BOONES FERRY RD
Application description: ELECTRICAL O SUITE 100
Property Zoning: MEDIUM DENSITY RES d PORTLAND, OR 97224
Application valuation: 1000
�ryR ntractor:
Applicant: Architect or Engineer: 02?O®fie AVIS/REED CONSTRUCTION INC`
OF �! 69 SAXONY ROAD, SUITE 105
�l �Q(/ NCINITAS, CA 92024 .
r/� CE��p '4 (760)634-2350
(�^ Lic. No. : 813480
---- --- ---------------------- - ---- ----------- -------- ------------- - -- --- - ---- --- - ------ - ---- -- ---
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjur that I am licensed under provisions of Chapter 9(comm fcing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000)of Division 3 of the B sin s and Professi als Code,and my Lic s is in full f rce and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
Lice�eCI s: License No.: 81 �} for by Section 3700 of the Labor Co pe orman a work for which this permit is
issued.
Datentractor: 1, I have and will maintain w rs'compensation insurance,as required by coon 3700 of the Labor
Code,for the perf ance of the work for which this permit is issued. My workers'compensation
OWNER-BUILDER DECLARATION insurance carr' 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 Po' mber 889200
following reason(Sec.7031.5.Business and Professions Code: Any city or county that requires a permit to _ I certify that,in a performance a ork fo this it' ssued,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the rson in any ma o Fk 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 nd agree that,if I sho ec su ' or sation 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 C e,1 1 th those provision .
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).: ate: plican
(_) 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 WARN FAILURE TO URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND'SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJ AN EMPLOYER TO CRIMINAL PENALTIES 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 DOL S($100,000). IN ADDITION TO THE COST 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.). APPLICANT ACKNOWLEDGEMENT
I=1 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. ,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 Quinta,its officers,agents and employees for any act 0siert.rel the work being
performed under or following issuance of this per
Date: Owner: 2. Any permit issued as a result of this applic -comes null and void if work is not comme ed
within 180 days from date of issua of such permit,or cessation of work for 180 days will ubject
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 av ead this application an state that the above i at i corre . I agree to comply w th all
work for which this permit is issued(Sec.3097,Civ.C.). city.and u y dinances d state laws lating to building ru eby autho' present wes
of t y er n the above-menti d property ins ses.
Lender's Name:
Dat Signature(Applicant or Agen
Lender's Address:
LQPERMIT
Application Number . . . 06-00000844
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33 .50 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/28/06
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
----------------------------------------------------------------------------
Special Notes and Comments
200 AMP WALL MOUNTED METER
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