05-3557 (ELEC)P.O. BOX 1504
78i,495-CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: "r_ -0000355
Property.Address: 47647 CALEO BAY
APN: 643 -200 -004 -
Application description: ELECTRICAL
Property Zoning: COMMUNITY COMMERCIAL
Application valuation: 12000.
T—,iht 4 4 Q"
Applicant: Architect or.Engineer:
C_er�t'10L�-11_�
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D Owner:
LA QUINTA MEDICAL PARTNERSHIP
5500 TRABUCO RD #100
SEP 2 2005 IRVINE, CA 92620
CITY OF LA QUINTA
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 Class: A B C8 C27 / Licen a No.: 181805
-,"'Date:^� Contractor!
OWNER.BUI ER 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 fila 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 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).:
1 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.).
1 _ 1 1, 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.).
( 1 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 the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Contractor:
DIFFENBAUGH INC, J D
6865 AIRPORT DRIVE
RIVERSIDE, CA 92504
(951)351-6865
Lic. No.: 181805
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 9/01/05
---------------s--------------------------------
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 AMER CASUALTY Policy Number WC274965862
I 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 workers' compensation provisions of Section
C� 3700 of the Labor CoA, I all forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPE SATION 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.
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 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
of this county to enter upon the above-mentioned property f I ins ction purp as
D '4`a S Signature (Applicant or Agent):
Application Number . . . . . 05-00003557
Permit . .
. BUILDING PERMIT
Additional desc .
Permit Fee . . .
. 135.00
Plan Check
Fee
87.75
Issue Date . . .
.
Valuation
.
. 12000
Expiration Date
2/28/06
Qty Unit Charge Per
'Extension
BASE FEE
45.00
10.00 9.0000 THOU BLDG 2,001-25,000
---------------------------------------=------------------------------------
90.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . .
. 27.00
Plan Check
Fee
6.75
Issue Date . . .
.
Valuation
. . . .
0
Expiration Date .
. 2/28/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
16.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
12.00
-------------------------------------------------------------=--------------
Special Notes and
Comments
Sixteen (16) Site
Light Standards
-----------------------
Other Fees . . .
----------------------------------------------------
. . . . . . ENERGY
REVIEW FEE
8.78
STRONG
MOTION (SMI)
- COM
2.52
Fee summary
-----------------
Charged Paid
----------
Credited
Due
Permit Fee Total
----------
162.00
----------
.00
----------
.00
162.00
Plan Check Total
94.50
.00
.00
94.50
Other Fee Total
11.30
.00
.00
11.30
Grand Total
267.80
.00
.00
267.80
LQPERMIT
L A
Cit of La uinta • D �i
Y Q
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico F,00cL
La Quinta, CA 92253 - (760) 777-7012
Building. Permit Application and Tracking Sheet
Peamit N ��7
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'n,�s
Project Address: #q-4,11-7�7 -eoZj�,lOwner's
Name: e N
A. P. Number:
Address'
Legal Description:
City, ST, Zip: N�
Contractor: i/
l
TePhn 11
e
Address:
Project Description:
(1
City, ST, Zip: STT , G S�
Telephone-.
State Lic. # : �' / �(% Sr
City Lir. #:
Arch., Engr., Designer—/4:eL
Address: 4l✓� Q
Constructton Type:_a Oc u an cY•
City, ST, Zip: Lf u
Te1e hone: lD
ic. #:7/S 6v
Alter Repairair Demo
Project type(circle one): (New Ad n
Name of Contact Person:
Sq'.t�
Unit
Telephone # of Contact Person.
Estimated Value of Projec ! Z,, o0O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd .
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
$ p
Item
Amount
ZStructural
Calcs.
Reviewed, ready for corrections 01Plan
Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for correcti s/issue
41"10-5
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of per
School Fees
Total Permit Fees
cb 0
6 /3 t�.5
/o