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06-1050 (ELEC)P.O. BOX 1504 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: 4/07/06 Application Number:06--coo- Owner: Property Address: E53035 MERIWETHER WY EAST OF MADISON LLC'' APN: 767-200-998-80 -330761- O PO BOX 1482 Application description: ELECTRICAL 6 LA QUINTA, CA 92247 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2500 APR 7 QO46 Contractor: «' Applicant: Architect or Engineer. BRUDVIK, INC. 600 EUGENE ROAD PALM SPRINGS, CA 92264 Q3�3 (760)320-4429 Lic. No.: 482623 -----------------.------=------------------------------------------------------------ ------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of'the following declarations: - Section 7000) of Division 3 of the Business a7 Prof ionals Code, and my License is in full force and effect. _ I have and willmaintain a certificate of consent to self -insure for workers' compensation, as provided Licensess C1 ' C20 C3, License No.: 482623 .for by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. /nate:' / ractor: - _ 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 OWNER -BUILDER EC�ARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contrac is State License Law for, the Carrier INS CO OF WEST Policy Number WSD21878101 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _. I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the, workers' 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 .and agreethat, if I shouldr�/ecome ubject to the workers' compensation provisions ofSection License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or -� 700 of�the Labor C"_ /I sh4! J rt with comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by i .✓Iany applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date. 6 �Wtant: (_ 1 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSA N COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT 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 DOLLARS ($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 ' (_ 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, (_) 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 or omission related to the work being ' - - performed under or following issuance of this permit. Date: Owner: 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 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 have read this application and state that the above infor ation is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to�ding onstr ion, and hereby authorize representatives -this co t to a te;nature pon the above-mentioned prop ty r n purposes. . Lender's Name: Date: (Applicant or Agent): Lender's Address: LQPERAIIT - . LQPERMIT A Application Number 06-00001050 `1 Permit ' . . . . ' ELEC-MISCELLANEOUS Additional desc . Permit Fee- 90.00, Plan Check Fee 22.50 Issue Date Valuation 0 Expiration Date 10/04/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 75.0000 EA,'"_ ELEC SVC >600V OR,>1000A 75.00 Special Notes and Comments ELECTRICAL SERVICE #6 NEW 1600 AMP, 277/480V 3PH 4W (NEAR CLUBHOUSE) 2001 CBC, 2004 CEC CODES _. Fee summary Charged Paid Credited Due Permit Fee Total, 90.00 .00 .00 90.00 Plan Check Total 22.50 .00 .00 22.50 Grand Total 112.50. .00 .00 112.50 LQPERMIT Bin # City of La Quinta : : Building U Safety Division P.O: Box 1504, 78-495 Calle Tampico. , La Quinta, CA 92253•- (760) 777-7012 Building Permit Application and Tracking Sheet a Permit # / Project Address:' S 3 -0 35 me,,, t we T v- (n! Owner'.s Name: A. P. Number: Address: Legal Description: Contractor: V J V L . � L City; ST, Zip: Telephone: Q` ` —50%Z Address: '•UQ EnU e—, Project Description: 0 City, ST, Zip: Lf, - Telephone: City Lic. #: State Lic. # :Z e%v IG e. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: , s_ State Lic. #:. Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo. Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Projec . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. . ,PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss•Calcs.. Called Contact Person Plan Check Balance Energy. Calcs. Plans picked up Construction Flood plain plan. Plans resubmitted Mechanical Grading, plan 2"' Review, ready for correction /i sue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 1rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue \ School Fees Total Permit Fees 2 .