08-0771 (ELEC)C
P.O. BOX 1504 ^'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENTVIP
BUILDING -PERMIT
Application Number:
Property Address:
APN:
Application description:
'PrQporty 7Qning-
Application valuation:
Applicant:
e��
08700000771
81689 RUSTIC CANYON DR
764-270-999-145 -300231-.
ELECTRICAL
LOW DENSITY_ RESIDENTIAL
2000 RESIDENTIAL
Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License`CI ss: /B� 1-jr—se-N-4 7 2 2 8 5
Date_ t7 �p'Contract
OWNER -BUILDER DECLARATION -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's State
License Law (Chapter 9 (commencing with Section 70001 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
1 _ )' 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 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.).
(_) 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 wither contractor(s) licensed -
pursuant to the Contractors' State License Law.). -
(_ ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty. of perjury that there is a construction.lending agency for theperformance of the
work for which this permit is issued ISec. 3097, Civ. C.). -
Lender's Name:
Lender's Address:
LQPERA11T
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 3
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253
(760)777-6005
LiC. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/06/08
------------------
WORKER'S 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 of the work for which this permit is
issued.
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
insurance carrier and policy number are:
Carrier AMERICAN HOME Policy Number CA 1593364
1 certify that, in the performance of the work for which this permit is issued, 1 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 sation provisions of Section
3700 of the Labor C forthwith co y with those provi ns.
Date: ^ u toy Applicant:
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 (5100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 that) have read this application and state that the above information is correct. I a9;g949.eQQ2Iy with all
city and county ordinances and state laws relating to building construction, and hereby Orize represe tatives
of this c ty enter upon the above-mentioned propert cion purposes.
'--
. Date:•. � Signature - (Applicant or Agent):
r
,•• Application Number . . . 08-00000771
:._. Permit . . .ELEC-MISCELLANEOUS
Additional desc
,- Permit Fee. 41.00 Plan Check
Fee ..
.00
Issue.•Date Valuation
0
Expiration'Date . 11/02/08
. Qty Unit Charge Per
Extension
" BASE . FEE
15.00
'.1:00, 7.5000 Ell ELEC, TEMP'SUB POLE
7.50 - -
1.00. 18.5000 EA ELEC SVC <=600V/<=200P
.18.50._
Special Notes and Comments
2.00 -AMP ELECTRICAL SERVICE PEDESTAL &
.SUB PANEL FOR COMFORT STATION PER MAP
&GB
Fee summary Charged Paid Credited
Due
Permit Fee Total 41..00 .00
----------
.00
41.00
Plan Check Total .00 00
.0.0 -
.00
Grand Total 41.00 .00
.00
41.00
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FA#F
City of La Quinta
Plan Check submitted
a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La
Amount
®� s
Quanta, CA 92253 - (760) 777-7012
Building
Called Contact Person
Permit Application and Tracking Sheet
Project Address: O '
�j8 Ns c Cant r / Owner's Name:
A. P. Number.
Address: ,�-
Legal Description:
City, ST, Zip:
Contractor: ��
-- 1M �S �i'v� Telephone:
Address:
Project Description:
City, ST Zip:
Grading
Telephone:
. .
e V, s -
Ctate r ;n It .
A•I•P•P•
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Stafe Lk. #:
Name of Contact Person:
Telephone # of Contact Person:
Il Submittal Rt
Plan Sets
Structural Calcs.
Truss Cala.
Energy files.
Flood plain plan,,
Grading.plau
Subcoutactor List
GranfDeed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
� - - ®1<;�- 7Bj ►ZBj�� - _ 1�
Construction Type: Oc�upaacy:
Project type (circle one): New . Add -n ' Alter Repair Demo
_...._ . ... - ._ . Sq. Ft.: # Stories: #Units:
Estimated Valu'
e -of Project: d •�� . b
APPLICANT:. DO NOT WRITE BELOW THIS UNE.
I a Rec, d TRACING .
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed; ready for corrections
Plan heck Deposit
Called Contact Person
Plan Check Balance
Plans Picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for eorrecdons/issue
Electrical
Called'Contact Person
Plumbing
Plans. picked up
S-M.I.
Plans resubmitted
Grading
Review, ready for corrections/issue
]Developer Impart Fee
Called Contact Person
A•I•P•P•
Date of permlt issue
- - -- - — Total Permit Fees --