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04-5152 (ELEC)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 . . . . . 04-00005152 Date 6/24/04 Property Address . . . . . . 81815 BROWN DEER PARK APN: 767-540-018- - - 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 ----------------------------------------------------- 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 ,NU .00 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 • Qaw& BUILDING & SAFETY DEPARTMENT r VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: _n V'- Sls --) Applicant: I Architect or Engineer: Date: Applicant's Mailing Address: Architect or Engineer's Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm undergri ty 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 Licenlls i foorce and effect. License Class License No. Date V Contractor k4q t+(�� � Kos 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 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 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 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 m tai ers' compensation insurance, as regy redMelon 3700 0 the Labor Code, for the performance of the work for which this permit is j—uep jvly e' nsation insurance carrier�O�dQlicJ �•SoCarrier ]► N pJ Policy Number r V` 7' 0 —I certify that, in the perform icy of he 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 Calif is and agree that, if I shou ecome to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos ions. 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.). Lender's 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 u er or following issuance of this permit. 2. Any permit issued as a result of this application bec mes null and void if wo of comm 'thin 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to an ellation. I certify that I have read this application and state that the ab d inf nation is correct. I e to' ply all city and county ordinances and state laws relating to building construc on, an ereby authorize representatives of this cou t t nter upon the abov ntioned pe rty for inspection purposes. 6 .•l ; Date Signature (Applicant or Agent): z m O m to 4 m m c m 6 w m TIBURON DRIVE JOB ID: 134516 ALIFORNIA COVE COMMUNITIES i Ac iAKITAIM©Q MocE ns LA QUINTA ' 3' BROWN DEER PARK MT.METER 14 �k8►. X17 16 13 12 11 ID 9 8 7 6 3 4 413 ' 3' BROWN DEER PARK MT.METER