05-3233 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92'253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
05-00003233
8.1897 COUPLES CT
764-060-040- -
ELECTRICAL
LOW DENSITY RESIDENTIAL
500
Architect or
T -1
-A,!t °F �Q�w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
d11A
LICENSED CONTRACTOR'S DECLARATION
(hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division.3 of the Business and: Professionals Code, and my LicensaIs in full force and effect.
License Case: B- Lioense No.: 760044
ate:tractor:
OWNER-BLII LDER. DECLARATI ON
i hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Lew 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 epplicarrt for the
permit to file a signed statement that he or sheds licensed, pursuant to the provisiorts!af the Contractor's State
License Law (Chapter9 (commencing with Section 7000) of; Division 3 o the Businessand 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-applicanttfor"a "permit subjects thwapplicant to a civil penalty of notmore'than five hundred dollars, ($500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will.do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State Ucense.Law does not apply to an ownerof 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 orimprovement is sold within
one year of completion, the owner -builder wig.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 construcuthe project (Sec.
7044; Business and Professions Coder The Contractors' State License Law does+not apply to an owner of
propertywho builds or improves thereon; end who contracts for the projects with a contractor(s) licensed
pursuant to thwContractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for'this reason
Date:
Owner.
CONSTRUCTION LENDINGIAGENCY
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: 0 A
LQPE RbUT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/27/05
Owner:
BIRDIE HOMES, III, LLC
300 E. STATE STREET, STE.100
REDLANDS, CA 92373
Contractor:
FIRST PACIFICA DEV CORP
3,00 EAST STATE ST, SUITE #100
REDLANDS, CA 92373
(909)798-3688
Lic.. No.: 760044
------------------
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.
1 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 STATE FUND Policy Number
I shall not employ any
person imany manner so as to 49W.Tesubject to the workers' compensation laws -of California,
and agree at, if I s beco a jest to workers' compensation provisions of Section.
3700 of the Labor I shall orth ith c with those provisions.
ate;:- Ilea
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 18100,000). IN AUDITION TO THE COST OF COMPENSATION, D_AM_AG_ES.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 pursuantto 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 Quints; its officers, agents and employees for any actor 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 abov rination is c ect. I agree to comply with all
city and county ordinances and state laws relating tobui ing _c6listron, eby authorize representativesof,this cingity t enteruPon M
above-mentioned W for
e:- nature (Applicant or -
Application Number . . . . . 05-000.0.3233
Permit . .
. ELEC-MISCELLANEOUS
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date
Valuation.
0
Expiration.Date
1/23/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 15.0000 EA ELEC
TEMPORARY POWER POLE
15..00
---- -- ------------
Special Notes and
Comments
TEMP POWER POLE
Fee summary
Charged
Paid Credited
Due
Permit Fee. Total
30.00
.00 .00
30:00
Plan Check
.00
.00 .00
.00
_Total:
Grand Total
30.00
.00 .00
30.00
LQrmtmr
Jul 27 05 12:28p THE PALMS 7607771965 PI
Y
Rin #
City of La Quanta
Dining K Safety Dkbbn
P.O. Box 1504, 78.495 Cage Tmwko
La Okwr CA 92253 - (740) 777-7012
Bullring Permit Application and Tracking Sheer
Permit
Project.Address:
'act's
tt r s 1�Ftotte: i
Addtcss: 3 !� Cv
Citn•..ST. Zip:
eFep[to
Ptt-ject Description: lagrcA L
A P. Titanber.
Legal Da rtiption:
Coninctor
Mft= co 5T Qa
Citi . ST. Zip: S Z
te. C!)
Telephone:pq
p
State Lir-#:
Cit%• Lic.
Arch.. Engt_ Designer.
Address:
City. ST. Zip:
Telephone:
State Lia :
Time of Cow= Person:
Consttuetion T) -pe: Oeeupartc}~
ProjectType icirtle onel: New • Add'n alter Repair Demo
Sq. FL: n Stories: Units
1 Telephone # of Contact Person: Q .,-
Estimated Value of P COCA:
APPLICANT: DO NOT WRITE BELOW THIS UNE
!f
Setbutittal
Req'd
Reed
TR.%CKING
PERMIT MIS
Plan Sets
Pian Cheek submitted
Item
Amount
Structural files
Rev'eeweel. ready for corrections
Plan Check- Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
TideN Cala.
Plans picked up
C nx%truction
Flood plain plan
Plains resubmitted
Mechanical
Grading plan-
2" Review. ready for eo *cclionslissue
Electrical
Subeomaetor list
Called Contact Terson
Plumbing
Grant Deed
Plass.pie:ked up
S U.
H.O.A. Approval
Plans resubmitted
Gradiar
IN HOUS&-
>a Review. ready for eorrectiooslttsue
Developer Impact Fee
Planedat Approval
Called Contact Person
Pob. Alla. Appr
Date of permit issue
School Fees
Total Permit Fees