04-3619 (ELEC)BUILDING &. SAFETY DEPARTMENT
P.O. BOX 1504 (760) 7774012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA Q.UINTA, CALiFORNJA 92253 INSPECTION REQUESTS (760)-777-7153-
BUILDING PERMIT
Application Number F4-00003619 Date 4/21/04
Property Address 78945 HIGHWAY 111'
APN: 643-020-999-6. -30903 -
,.Application description ELECTRICAL
Property. Zoning REGIONAL COMMERCIAL
Application valuation .. 500.
-Owner Contractor
WASHINGTON -111 LTD BRAY CORP,. -'SR DBA POWER PLUS
C/O,JOHN ANDERHOLT 1005-N. EDWARD. CT
BOX 1623.. ANAHEIM.... . ... CA 92806:.. ,
:PALM; DESERT ..CA 922-6:1. (714).:-28'8=83.66
WCC': STATE FUND:`
:.,WC.:; .19787.2;004 01./01/05
1
SL
' - C B: � 5235`96: 01/ 3/06
CCC:.. B=.C6.1�=C1:-I?31.
.: Permit ELEC-TEMPORARY POWER .
Additional'desc .
Permit Fee. 52.50 Plan Check Fee .00
Issue Date . . . : Valuation 0
...Qty Unit Charge Per 'Extension
BASE, FEE 15.00
1. 00 . `15 0000- EA ELEC .TEMPORARY POWER :. POLE : 15.00
3..00 .7...5 0 0'0.- EA ELEC. TEMP: SUB :POLE ` 2'2 : 50
Special Notes. and Comments
ONE TEMP -.POWER POLE WITH .3 SUB -POLES
STEINMART.SITE.
Fee summary Charged Paid. Credited Due
Permit Fee Total .52.50~ :00` ...00 52.50
Plan Check. Total .00 .00 .00 .00
Grand Total 52.50 .00 ..00 52..50.
nn
.. � .. a lJ...
APR -2 1 2004
CITY OF LA OUe7dYe. '
P.O. BoX 1504 • /; s
�/ VOICE (760) 777-7012
78-495 CALLE TAMPICO - FAX .(760) 777-7011
LA QUINTA, CALIFORNIA 92253 440
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. Date:
Applicant: Architect or Engineer
Applicant's Mailing Address: Architect ngineer's Address:
S�l ".1G
tic. No.
BUILDING PERMIT DECLARATIONS .
hereby affirm under of LICENSED CONTRACTOR'S DECLARATION
1
perjummy rias I am licensed under provisions of Chapter p ncinp with Section 7000) of Division 3 of the Business and Pm(essionals
Coda. my Urenuo force and effect
License2ss Lire 110.
1 Y+ 4nn penalty or Par1orY ttma! I am OWNER -BUILDER DECLARATION
exempt from lha Contractors' Stab Lioense Law for the following reason (Sec. 703,1.5. Business and Professions Code: Any
CY or cm4y that a gem* b construct, aIW. improve. demolish. or repair any structure. prior b its issuance, also nequires the applicant for" permit b fie a signed
statement Murat he* she is licensed puramt b the povisloru or the Conbacbrs' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he 0'rshe is exempt lteretrom and the basis for rie alleged exemption. Any violation of Section 7031.5 by any sF; kart fora permit subjects
tine applicant lo a dui penalty of not more than live hundred dollars 0500).):
U 1, as owner. of the property. or my employees with wages gs their 6018 compensation, wi do the work. and the structure Is not Intended or otered for sale (Sec. 7044,
Business and Professions Code: The Contragots' stab license Law does not apply b an owner of property-whro builds or improves thereon; and who does the work
himself or herself or through his or her own employees, provided that the irprove ents aro not Intended or offered for sale. K, howeyer, the bt"V or improvement is
SM within one year of cWVleli(n; the owner Milder will have the burden of proving Out he or she did not build or improve for the purpose of sale.).
U Las owner of to property, am exdwA-ely contracting with licensed contracbrs b construct the pact (Sec. 7044. Business and Professions Code: The Contractors'
State License Law does not appy b an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant b
the Contractors' state License Law.).
C.) I slim exempt under sec. . B.6 P.C. for anis reason
Dale' Owtmer .
1 hereby affirm under penalty of perjury one of the WORKERS' COMPENSATION DECLARATION
I have and wil maintain a eerffcate of consent b ere for workers'
of the work for which this permit is issued..00n as provided for by Section 3700 of the Labor Code. for the performance
1 have and maintain workers'insula , as required t 3700 of the Labor Code, for the performance of the wank for which this permit is
C
arter P6tigr Num
e«
145
�broNsi?(xof Mme lion wf>ich it is ed. l shall not employ any person in any manner so is to become subject rs'
b I e worke
taws of
I0rrply with th ase e A should compensation of Section 3700 of rie Labor Code. I stint
WARNING:` FAILURE TO SECURE WORKERS C IS UNLAWFUL, SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE FNRrDRED THpUSMItjpOLIARS (t1 ,000). IN IONTO THE C T OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABORCODE, lffTEREST, AND ATT EY5 FE
1 hereby affirm underC LENDtN GENCY
f Y d Dorlm+rY that there • tle pert of the work for which this permit is Issued (Sec. 9097. Civ. C.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Apptica ' �hee�bymade to the Director of Budding and Safety for aper it subject b the conditions and restrictions set forth on this application.
I. Each person upon wos behalf Oft application is made, each person at.whose request and for whose benefit work is performed under or pursuant b. any pem*
Issued as a result of officers, ��Lon' the owner, grid the applicant, each agrees b. and shad, defend, Inde ' y and hold harmless the City of La Ouk ter. Its
agents and employees for any act or omission related b the work being performed under oft ng Issuance of ills perridt
2 Any permit issued as a result of this application becomes nud and void lf work is not commenced 80 d4Ys from date of Issuance of such permit, or
cessation d work for 180 days carp subject pem* b ca
1 certify fiat I have this application and state that the a frit onNVand autlmortze representatives of this b erity and county ordamanoes and state laws relating b building
upnspection purposes.
Date Signature (Applicant or Agent):