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04-7644 (ELEC)C_ I IIIIIII VIII II f'+.` IIIIIIIIII 10 L� Q• ----- IE__ ----- BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 C�i11OF, ( � 78-495 CALLE TAMPICO FAX (760) 777-7011 GIN�.�,����LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00'007644 12/07/04 Property Address . . . . . . 80690 AVENUE 52 /A -Date - #4 APN: 772-270'-010- - Application description . . . ELECTR•ICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 500 Owner Contractor ------------------------ ------------------------ RA WASSERMAN BRAY CORP, SR DBA POWER PLUS 77955 CALLE TAMPICO 1005 N. EDWARD CT LA QUINTA CA 92253 ANAHEIM CA 92806 (714) 288-8366 WCC: STATE FUND. WC: 197872004 01/01/05 CSLB: 523596 01/13/06 CCC: B -C61 -C1 -D31 ---------------------------------------------------------------------------- Permit ELEC-TEMPORARY_ POWER Additional desc . . Permit•Fee'. . . . 52.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 15.0000 EA ELEC TEMPORARY POWER POLE 30.00 1.00 7.5000 EA ELEC TEMP SUB POLE 7.50 ---------------------------------------------------------------------------- Special Notes and Comments 2 TEMP POWER POLES 200 AMP OVERHEAD WITH 1 SUBPOLE AND 3 BAREPOLES FOR TRACT 31123 Fee summary Charged ----------------- ---------- Permit Fee Total 52.50 Plan Check Total .00 Grand Total 52.50 Paid Credited Due ---------- -------- -- ---------- ..00 .00 52.50 .00 .00 .00 .00 .00 52.50 J P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under peUY It perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License iI& and effect. S 2 3S I C{ License Class VV License No. Date 2 Contractor U K 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 1, 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 contractors) 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 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 mai �`yn w��•p��y`s' compyr'sation insure, gs requiredSection 700 of the Labor Code, for the performance of the work for which this permit is i Carrier.411-1 U 1 1 T' #Iicy Number ' VN�.. _ I certify that, in the performance of work for which this p rmit is i compensation laws of CA�ndhat, ifIshou beton forthhwitthh comply with thDate t�7 ApplicantWARNING: FA URE TO SECURE WSATION C ERA I CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ,000), IN A SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I all not employ ani person in any manner so as to become subject to the workers' act to the workers' compensation provisions of Section 3700 of the Labor Code, I shall IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND )ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 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.). Lenders Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the cc 1. Each person upon whose behalf this application is made, eat erson at wh request and for issued as a result of this application, the owner, and the apply nt, each agre s , and shall, fde ( officers, agents and employees for any actor omission relay6 to the work being erforned un 2. Any permit issued as a result of this application becomes 6nL an void if work is n t comman cessation of work for 180 days will subject permit to can I do I certify that I have read this application and state that the above in ' ati • is cored. I gree to compl wi construction, and hereby authorize representatives of this county to p the abo -men oned pr p Date v 7 1! Signature (Applicant or Agent): idi and restrictions set forth on this application. ose be efit work is performed under or pursuant to any permit ;nd, inde nify and hold harmless the City of La Quinta, its r or follow ng issuance of this permit. within 1 0 days from date of issuance of such permit, or city and county ordinances and state laws relating to building inspection purposes.