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07-1821 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4 -ht " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 07-00001821 Owner: Property Address: 78738 HIGHWAY 111 LA QUINTA FURNITURE LLC APN: 643-220-004- - - 1919 GRAND AVE #2A Application description: ELECTRICAL SAN DIEGO, CA 92109 Property Zoning: REGIONAL COMMERCIAL Application valuation: 100 i �I JI Contractor: Applicant: Architect or Engineer: CONSOLIDATED CONTRACTI C ST VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/21/07 Lna � 1 INC. I1 IM C. • 46753 ADAMS REET P i 210 7J� LA QUINTA, CA 92253 (760) 771-3345 CITY OFLAQiIlYr� Lic. No.: 824183 Fd���S%° ------------------------------------------------------------------------------------------------- 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 Licen CI s: P C8 _ License No.: 824183 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: D� 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 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 1770749-2007. 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, 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 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 3 00 of the 2bor Code shall fo thwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Arty 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).: pplicant: (_) 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 WARNING: FAILURE TO SECU 0 ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State Cicense 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, 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, 1 ) 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 Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the perfoimance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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 that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofWte; anr'uupon the above-mentioned property fa ' specti purposes. 9i ture (Applicant or Agent): ' LQPERMIT Application Number . . . . 07-00001821 Permit . . . ELEC-TEMPORARY POWER Additional desc . Permit Fee . . 30.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 0 Expiration Date 12/18/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 -----------------------------------------------------------------=---------- .Special Notes and Comments TEMP POWER POLE & 2 BARE POLES FOR NEW CONSTRUCTION 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 Bin # i City of La Quinta Building U Safety Division naj P.O:-Box 1504, 78-495 Calle Tampico AW N La Quinta, CA 92253 - (760) 777-7012 I&Building lding Permit Application and Tracking Sheet Permit_# 1 V Project Address:'26,756--t-6d,/ (( Owner's Name: A. P. Number: �� Z� Address: l�G�• �C�� l - Legal Description: L 4 (�� �• lM ,3 k.1 . Contractor: f�l/l�(.1� .�� i City, ST, Zip: ��YIc�UVb� CA Telephone: Project Description: Address: -7.< City, ST, Zip: 'A _ l 7,-I,<.M. Telephone: 1116 -17l . 3 34 b State Lic. #: 24- 183 City Lic. #: Arch., Engr., Designer: CAu two JOE . s •�, j�. OS- 1 Address: (�11f City, ST, Zip: ►V cZW 1. Telephone: 7bO . 2.4-) ') State Lic. #: Name of Contact Person: LA, -\ Construction Type: v_ I Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft. -# Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: Q APPLICANT: DO NOT WRITE BELOW THIS LINE It Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. 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,plau 2"' Review, ready for correctionstiissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IlY HOUSE:- 3W Review, ready for corrections/issue Developer Impact Fee .. Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 3O .