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05-0584 (ELEC)Ed 4. Tdf 4 4 Q" BUILDING & SAFETY DEPARTMENT P.O. Box 1504- (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 . INSPECTION REQUESTS (760) 777-7153 • BUILDING PERMIT Application Number'-' . . . . 05''-000'00584 - Date 2/15/05 Property Address . . . . 81721 HIDDEN LINKS DR APN: 767 -200 -999 -33 -312022 - Application description . . . ELECTRICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation .. 2000 Owner Contractor DESERT-CHEYENNE, INC. ---------------- RIGHTWAY TEMPORARY POWER 78401 HIGHWAY 111, SUITE G 653 WEST MINTHOR STREET LA QUINTA CA 92253 LAKE ELSINORE CA 92530 (760) 777-9920 (909) 674-8608 WCC: STATE FUND WC: 1641639 05/30/05 CSLB: 388274 01/31/06 ----------------------------------------------=----------------------------- CCC: B' -C10 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee 90.00 Plan Check Fee 22.50 Issue Date .,. Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 - 10.00 7.5000 EA ELEC TEMP SUB POLE ---------------------------------------I------------------------------------- - 75.00 Special Notes and Comments 1 TEMP POWER METER, 10 SERVICE POLES & 14 STRINGER POLES Fee summary Charged Paid Credited ----------------- Due ---------- PermitFee Total ------------------------------- --------=Permit 90.00 .00 .00 90.00 Plan Check Total 2.2.50 .00 .00 22.50 Grand Total 112.50 .00 .00 112.50 t D FEB 15 2005 CITY OF LA QUINTA FINANCE 139PT JIM P.O. BOX 1504 78-495 CALLS TAMPICO VOFAX ICE (760) 777-7012760 777-7011 LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: _ U - Applicant: Applicant's Mailing Address: Date: .2 /5.05 Architect or Engineer: Architect or Engineer's Address: c7 l Lic. No.: MUIL-UINU FLKMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (com encing with Section 7000) of Division 3 of the Business and Professionals Code, and my,LTc�nsQ isrip full force and effect. license 'las ' I (Jicense No. 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 forthe 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 Owner. 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 k of the work for which this permit is issued. -I have and will maintain worke s' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i shed M' r' omp sation i nce carri r c n re: arrie olicy Number ��I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 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 Lenders Address 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 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. 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 permit to cancellation. I certify tha I haveead this application and state that a above information is correct. I agree to comply with all city and county ordinances and state laws relating to building constructio ,and reby authorize representatives is co ty to enter upon the above-mentioned property for inspection purposes. e /�-!�Sgnature (App nt or Agent): rviode-t 5 ",r%53-055 Tr -Lars 150 TX PN*rcr 2 &.. rsYg 0 - 50 r L v ,! � •Y: � G.1P nMa .D�D�Oo 6�=OOo £� [� o ---i � � � ► � DoT � I �, _ s� 16a I �� 16• �• I 8 99 9516,6150 28 27 26 25 24 23 92� 62 42 Q 29 30 31 32 33 cc Q 94 61 43 ~ qD — — 96 60 o — ►4,4 41' O — T44 te-,et 4-rAw ?-"I O 9 (- eP �® t - ai x - price MOB SMMerPales 0- 1 34 19 14 61 X40- 39 38 37 38 35 977 4�1 ,4�gf �—C ARISMATIC AY ..' 49'5 51�• 52 63 54 55 5" 20 a2 1491 �0 I So I Sol 3711 so - - 29 22 231 29 1 X30 _ '(')-004 Z , -005 © Copyright 2004 g MSA ConsultinInc. All RiFch+c Roca. .A 60 58 57 X's — b� WHO DC�D=0000 =00 900 � O=©MCSTROM TR' AOL 1Mmep� 0' 100' - 200' SCALE 1 G.iM 767-060-0301 X301 E(QUESTO RAN FACOLOTOCS __T T_7 —1—T ✓�1 91Vol VI 2\ C ANTANA DR. 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