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04-5154 (ELEC)0 • �� o F U BUILDING & SAFETY DEPARTMENT O P.O. Bo`x 1504 (760).777-7012 OF� 78-4 ��L E TA Pico FAX (760) 777-7011 O QuI N,Cn IFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Applica pion Number . . . . . 04-00005154 Date 6/24/04 Property Address . . . . . . 81735 BROWN DEER PARK APN: 767 -540 -010 - Application description . . . ELECTRICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 500 Owner Contractor., -----------------------------------------------. SWC NORMAN 39 BRAY CORP, SR DBA POWER;PLUS C/O DAVID PEERY 1005 N. EDWARD CT 7161 INDIANA AVE ANAHEIM CA 92806 RIVERSIDE CA 92504 (714) 288-8366 WCC: STATE FUND WC: 197872004 01/01/05 CSLB: 523596 01/13/06 CCC: B -C61 -C1 -D31 --------------------7------------------------------------------------------- Permit . . . . . . ELEC-TEMPORARY POWER Additional desc . . Permit Fee . . . . 30.00 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 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 a i P.O. Box 1504�� VOICE (760) 777-7012 Tiff 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253. INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O — Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engine e 's d re Lic. No.: BUILDING PERMIT DECLARATIONS 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 it tv I(ce and effect. Q GoRnse ClasS License No. ��� l Date—4 zll v4 Contractor S. " &WP_ 5"t", bWM QLUS OWNER -BUILDER DECLARATION 1 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 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).): 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 projecf (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 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 of the work for which this permit is issued. _ I have and will ma in fsation ' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is :Pgsue y insurance cam�r,�%�P�cy�g�p a) ` Carrier W 8/ Policy Number n a►t�7 S V d V _ I certify that, in the performanc f re 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 Califo is and agree that, if I should beco bject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos �ov sions. i Date 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 ($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.). Lenders Name Lender's 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 b oes 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 c nceIlz tion. I certify that I have read this application and state that the ab aformation is correct. I e to co ly ith all city and county ordinances and state laws relating to building constructi n, and ereby authorize representatives of this co ty o enter upon the above- n ed party for inspection purposes. Date Signature (Applicant or Agent): ' W LOT 7 P2LC"R - 007 AODRESS 11 - 007 81 - 805 BROWN DEER PARK 18 3191 81 -- 815 BROWN DEER PARK 19 3C 55 -- 315 TURNBERRY WAY _ 20 2C 55 -- 345 TORNB RRY WAY 21 1 C 55 - 375 ' TUY WAY 22 3AR 55 - 405 TURNBERRY WAY 23 2A 55 - 435 TURNBERRY WAY 24 1 C 55 - 465 TURNBEIW WAY 25 28 55 - 485 TURNBERRY WAY 26 1A 55 - 525 TUY WAY 27 2CR 55 555 TAY WAY 28 3C 55 585 TURNBERRY WAY 29 18R 55 - 615 TURNBERRY WAY LAT# ADDRESS: 16 18R 81-795 BROWN DEER PARK 17 2AR 81-805 BLOWN DEER PARK ft 3BR 81-815 BROWN DEER PARK 767 - 330 - 007 767 - 330 - 007 767 - 330 - 008 767 - 330 -- 008 767 - 330 - 008 767 - 3 30 -008 767 - 330 - 008 767 - 330 -- 008 767 - 330 - 008 767 - 330 - 008 767 - 330 - 008 767 - 330 -- 040 767 - 330 - 040 APN: 767 - 540 - 016 767 -- 540 - 017 767 - 540 018 I© 73s- �< <. ilo7 - ��-- Oho.