ELEC (07-2181)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number: --07-00002183 —
Property Address: ' 81531 MERV GRIFFIN WY
APN: 767-320-999-68 -32879 -
Application description:- ' ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1200
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Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/25/07
Owner:
WORKER'S COMPENSATION DECLARATION
MCCOMIC GRIFFIN LLC
I hereby affirm under penalty of perjury one of the following declarations:
7979 IVANHOE AVE #550
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
LA-JOLLA, CA 92037
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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Contractor:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
COCHRAN COMMUNCATION
36630 CATHEDRAL CANYO
INC
VE
CATHEDRAL CITY, CA 922
insurance carrier and policy number are:
(760) 328-6778'
Carrier STATE FUND Policy Number 0008625-2007
Lic. No.: 478543.._
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
.' 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 and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C7 License No.: 478543 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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issued.
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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 DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 0008625-2007
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, atter, 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 agree that, if I should become subject to the workers' compensation provisions of Section,
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
3700 of the Labor Code, I shall.for with omply with those provisions.
_
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• - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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• (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAIL RE•TO SECURE WORKERS' COMPENSATION 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 1$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 C6de: 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,
(_ 1 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
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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 information 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 building construction, and hereby authorize representatives
_ lender's Name:
of this county to enter upo/he above-mentioned pro pe y for inspec 'on p oses. '
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D � e (Applicant or Agent): '
Lender's Address:• � -
LQPERMIT'
Application Number . . 07-00002181
Permit ELEC=MISCELLANEOUS
Additional desc .
Permit Fee 33.50 Plan Check Fee. 00
Issue Date Valuation 0
Expiration Date 1/21/08
Qty Unit Charge Per Extension
BASE FEE. -15.00.
1.00 18.5000 EA ELEC SVC <=600V/<=200A. 18.50
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Special Notes and Comments
100 AMP METER PEDESTAL ON RESIDENTIAL
LOT PER COCHRAN DRAWING
Fee summary Charged Paid Credited" Due
------- ------ ----------
Permit Fee Total 33.50 00 .00 33.50
Plan Check Total .00 .00 .00 .00
..Grand Total 33.50 .00 .00 33.50
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LQPERMIT - - -
50
' Lot # 138
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City of La Quinta TO`~
^Building 8Z Safery DivisionP.O. Box 150478-495 Calle TampicoLa Quinta, CA 92253Building Permit Application and Tracking SheetProject Address: Owner's Name: TIML W/fg/yfft chozz
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City.ST, Zip:
State Lic. 9 795 Y3
City Lic. 50-9
Arch., Engr.. Designer:
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Construction Type: Occupancy: NA
Name of Contact Person:
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Sq. Ft.. # Stories:
# Units:
Telephone 4 of Contact Person:
Esdinated Value of Ptoject: /Z
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