ELEC (06-0513)P.O. BOY 1504'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:06 - OO QO Q 513
Property Address: 61007 .MONROE ST
APN: 764-280-,014- - -
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: �00
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Owner:
MONROE DATES
1387 AMBASSADOR WAY
SALT LAKE CITY, UT 84108
Contractor:
SHEA HOMES, INC.
81260 AVENUE 62
LA QUINTA,'CA 92253
(760)777-6005
Lic..No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/02/06
FEg 06 20
D066 UI
El—TV OF LA
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LICENSED CONTRACTOR'S DECLARATION
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-� WORKER'S COMPENSATION DECLARATION
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 Cl s: B - -. License No.: 672285
_
- for -by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
ntractor:
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the tabor
/
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 AMERICAN. HOME Policy Number 1247619 '
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 b ome 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 beco 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
3700 of the Labo od I shal orthwith 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
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any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ..
ate:
plica
( 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' 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 ($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.l. - -
whose benefit work is performed under or pursuant to any permit issued as a result of this:application,
(_) I am exempt under Sec. , BAP.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.
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 itding constructs n, and hereby authorize representatives
of this ty t enter upon the bove-mentioned pro r in a purposes.
Lender's Name:
'
'
ate: lure (Applicant or Agent �
Lender's Address:
. - LQPERMIT
-
LQPERMIT
Application Number . . . . . 06-00000513
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 30.00, Plan Check_Fee
.00
I"ssue Date . . . . Valuation
0
Expiration Date 8/01/06.
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE
15.00
.00 18.5000 EA ELEC SVC <=600V/<=200A
.00
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Special Notes and Comments
TEMP POWER POLE LOCATED 60.' SW OF THE
INTERSECTION OF MONROE & AVE. 61
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
LQPERMIT
Jan -10-2006.1 12:00 PM Shasta Electric 9096467482 212
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Jan -10,x2006, 12:00 PM Shasta Electric 9096467482,112'
•
SHASTA
ELECTRIC •I
655 Brea Canyon Road '
Walnut, California 91789
Telephone (909) 646-7483
Fax (909) 646-7482
~ ' .
FAX F •yam • • ,
Shea Homes Qa� Ben Ragel- Temporary Power Div Manager
Trilogy Cell (909) 821-8248
760-777-6024 l3en,Ragel(&-shastaelec dc.com ,
'®1/10/2006
r_,rMV=Gabbie Lares r
Number of pages induding cover: ` 2 -
Message:
Message: Please contact me when you receive this quote. We look forward to doing business with you. •-
Please also attach'your billing requirements and procedures on reciving invoices with the signed quote
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