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04-8047 (ELEC) r' 111111110111 12 IE os BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 OF T1 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . 04-00008047 Date 12/30/04 Property Address 8"97"71 CALLS AZUL APN: 762-240-003-37 -300962- Application description . . . ELECTRICAL Property Zoning . . . . .. . . MEDIUM DENSITY RES Application valuation 500 Owner Contractor --------------------------------- ---------------------------------- PUERTA AZUL PARTNERS DAVIS/REED CONSTRUCTION INC 17700 SW UPPER BOONES FERRY RD 169 SAXONY ROAD, STE #105 SUITE 100 ENCINITAS, CA 92024 PORTLAND, OR 97224 (760) 634-2350 WCC: STATE FUND WC: WC298892004 06/12/05 CSLB: 813480 10/31/06 • CCC: B ---------------------------------------------------------------------------- D as • � C 3 v 2004 C FINANCE DEPT.A P.O. BOX 1504 78-495 CALLS TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777.7153 BUILDING $ SAFETY DEPARTMENT Application Number: D t— �O`f Date: Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under of rjury that 1 am licensed under provisions of C r 9(commencing with Section 7000)of Division 3 of the Business and Professionals Code,and my License i full f rce and effect. Code, e CtZ Li Date' Cont�ractoG Z OWNER-BUILDER DECLARATION 1 here affirm under penalty of perjury t I am exempt from the Contractors'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 Contractors'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).): subje U 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 or 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.). U I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code: The Contract ' 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 pursuors ant to the Contractors'State License Law.). U I am exempt under Sec. ,BA P.C.for this reason Date Owner WORKERS'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 wo for which this permit is issued. _I ha nd 'll rrma' orkers'compensation ins u s required b S 700 o theC/ r rformance work for which this permit is work compo cation insuran artier and icy n er Came f Poli umber ! ce i the rforma a`of Ili o fiir whic is pe d,1 shall not a ploy any person in any manner as to become subject to the workers' com satin aws of Catifomi ,and agree if I sho subject to the ers'compensation provisions of Section 3700 of the Labor Code,I shall to th co ly with those ovisions. Date d 6 plicent 4 WARNIN : I RE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FI ES U O ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTI N 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I herebyaffirm under CONSTRUCTION LENDING AGENCY 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 t 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 a 1. Each person upon whose behalf this application is made,each person P at whose request and for whose benefit work is performed under or pplpursuant icato any permit tiorm. issued as a result of this application,the owner,and the applicant,each agrees to,and shall,defend,indemnity and hold harmless the City of Le Quints,its officers,agents and employees for any act of omission related to the o der or following issuance of this permit. 2. Any permit issued as a result of this application becomes n void if work is not common within 180 days from date of issuance of such permit-or cessation of work for 180 days will subject permit to ellation. I certify that I have jead VaPplication and state that the o s co ve info construction,and reb utho'ze representatives of coun of a to comply all city and county ordinances and state laws relating to building tY Po ntioned p rty for inspection purposes. Date Signature_ (Applieant-o►--en ---------------------------------------------------------------------------- �;.. . ��1� Application Number . . . 04-00008047 ---------------------------------------------------------------------------- Permit ELEC-TEMPORARY POWER Additional desc Permit Fee . . . . 30 . 00 Plan Check Fee . 00 Issue Date Valuation . . . . 0 Expiration Date 6/28/05 Qty Unit Charge Per Extension BASE FEE 15 . 00 1 . 00 15 . 0000 EA ELEC TEMPORARY POWER POLE 15 . 00 ---------------------------------------------------------------------------- Special Notes and Comments TEMP POWER POLE @ LOT 37 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 30 . 00 . 00 . 00 30 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 30 . 00 . 00 . 00 30 . 00