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04-6260 (ELEC)0 2� U P1010W O OFLAQUINTA I BUILDING & SAFETY DEPARTMENT A�R��e ��iT AP:OM'Brox;15,04 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 77.7-7153 BUILDING PERMIT Application Number . . . ... 04-00006260 Date 9/10/04 Property Address . . . . . . 80600 AVENUE -52 APN: 772 -270 -009 -1 -000000 - Application description . . . ELECTRICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL* Application valuation 500 Owner e Contractor ------------------------ ALPINE_REAL PROPERTY ------------------_----- BRAY CORP, -SR DBA POWER PLUS 41800 WASHINGTON ST B105-220 1005 N. EDWARD CT INDIO CA 92203 ANAHEIM CA 92806 (714) 288-8366 WCC: STATE FUND WC: 197872004 01/01/05 CSLB:, 523596 01/13/06 CCC: B -C.61 -C1 -D31 ---------------------------------------------------------------------------- Permit . . . . ELEC-MISCELLANEOUS Additional desc Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000,EA ,ELEC J TEMPORARY POWER POLE 15.00: Special Notes and Comments 200 AMP TEMP POWER POLE 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 P.O. Box 1504• VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011����.V LA QUINTA, CALIFORNIA 92253 T444INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ��- (o�l00 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: At Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals �e9e, and ss Licen is ' t force and effect. S Z 3S9 / License(�Class � ense No. �+ �tSate . • 1 ' ntract.r OWNER -BUILDER DECLARATION I hereby affirm under 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 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).): 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 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 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of peryury 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 mai air rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ue M wq rs rp�ensation ii ce carrier and y m r a / ,r7 2�rrier�Fly -T O F,f r /Policy N mbe I certify that, in the performan of the work fo hich IN ermit is iss ed, I shall not employ any person in any manner so as to become subject to the workers' compensation laws OIC if i , and agree th , if I shou subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with tho e r isions. Date �� �� � b� �Ilr'^} ✓---�� 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. CONSTRUCTION LENDING AGENCY I hereby affirm under 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 JV 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 application. 1. Each 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 shallpr�orfoll emnify and hold harmless the City of La Quinta, its officers, agents and employees for any actor omission related to the work being performed ing issuance of this permit. 2. Any permit issued as a result of this application beco es null and void i o 's not comme1 0 days from date of issuance of such permit, or cessation of work for 180 days will subject permit tocncellation. I certify that I have read this application and state that the abo fo ation is correct. I agree comply and county ordinances and state laws relating to building construuction, and hereby authorize representatives of this cou t o nter upon the abo a mention prnspection purposes. ale —�" :. . . Signature (Applicant or Agent): ..�.�,.