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05-0121 (ELEC)-- IIIIIIIIVIIIIIIIIIIIIIII 22 IE • sum_ , -- - ---- ---J , • r. BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760),777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 Application Number . . . Property Address . . . . APN: Application description Property Zoning Application valuation BUILDING PERMIT 0�.0©0012-1 _Date 1/12/05 80175 AVENUE 52 772-410-018- - - ELECTRICAL HIGH DENSITY RESIDENTIAL 10000, Owner Contractor --------------------------------- ------------.--------------------- GREYSTONE GROUP GREYSTONE MULTI -FAM BUILDERS .341 BAYSIDE.DR #7 341 BAYSIDE DRIVE, #7 NEWPORT BEACH, CA 92660 NEWPORT BEACH, CA 92660 (94 9) 566-9230 WCC: ZENITH INS WC: Z066293901 08/24/05 CSLB: 774293 01/31/06 CCC: B ----------------------------------------------------------------------------- D � D JAN 12 2005 CITY OF LA QUINTA P.O. Box 1504 - • - 78-495 CALLS TAMPICO VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 '• ''- .. FAX,( -760) 771-7011 ,INSPECTIONS -;(f60) 777-7153 BUILDING & SAFETY DEPARTMENT C Application Number: JT Z f' Applicant: `Applicant's Mailing Address: . I hereby affirm under is in Z -Of_ Architect or Engineer: Date: Arcnitect or Engineer's Address: i, �Lic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION' of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of -Division. -3 of the Business and Professionals 1 force arjd effect. License No A,C4 (,/-/ 1 J6 . 1 herebyaffirm under OWNER -BUILDER DECLARATION penalty of perjury that 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 n file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Slate 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).): 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.). (, 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.). 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 work for which this permit is issued. _ 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 msu"'iance^ea?Mer-and-pWicy number are: Carrier. t 14 (AiT- Iom;_, u,.. "W -- certify that, in the performance of the work for whm this ­permit is issued. I shall not employ any person in any manner so as to become subject to the workers'• compensation laws 6f California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply withAhgse provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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. 1 hereby affirm under penaltyof CONSTRUCTION LENDING AGENCY perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lenders Name Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safe for a 1. .Each Safety permit subject to the conditions and restrictions set forth on this application. 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, indemnity 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. 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 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ---------------------------------------------------------------------------- • Application Number . . 05-00000121 -- - - - -t - - - -,L-----------,��-.y- ;- - - --<---------------------------- ----- - - - - -' - - -- Per At . . . . ELEC.-TEMPORARY POWER Additionalt'desc Permit Fee 187.50 Plan Check Fee.00 (° IssU.Date.. .. .. Valuation _ .�..,. 00 Qty Unit Charge Per Extension __..�_.... BASE FEE _.._. _ ., -.:.. : ; 15.,0Q 1.00 15;000.0 EA ELEC TEMPORARY POWER POLE' 15.00 21.00- ._.7.5000 EA ELEC TEMP SUB POLE 157.50 ----------------------------------- 7---------------------- =----- Special Notes and Comments 7-=_--------- - ONE TEMP POWER POLE WITH 21 ,.ADDITIONAL SUBPOLES :._._.-.._.._ . . Fee summary Charged Paid. Credited Due --------..-_-_-___-- ..---- - - - - ------ - - - - -- --,--- - - - -.-----•--_ Permit Fee Total 187.50 .00 ..`0 0, _.r 187.50 Plan Check Total 00 .00 .00" .00 Grand Total 187.50 .00 .00 187.50