05-4863 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00004863
Property Address:
81847 COUPLES CT
APN:
764 -060 -042 -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
T,�df 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that) am licensed under provisions of Chapter9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License, Class: B License No.:. 760044
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..6, Business and Professions Code: Any city. or county that requires a permit to
construct, alter, improve; demolish, or repair any structure, priorto 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 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($600)•:
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not'Imended 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 bullding or improvernerd 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 ofaale.).
(_ 11, 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 Lew does not apply twan 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.).
(_) I am exempt under Sec. , BAP: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 (Sec. 3097, Civ.. C.).
Lender's -Name:
Lender's Address:
LQPER31IIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/01/05
Owner:
BIRDIE HOMES,
300 E. STATE
REDLANDS,, CA
LLC
ST. STE. 100
011'17'2
Contractor:
FIRST PACIFICA DEV
300 EAST STATE.ST,
REDLANDS, CA 92373.
(909)7.98-3688
Lia.. No.: 760044
DLNOV11005
It OF LA QUINTA
FINANCE DEPT.
------------------
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:self4risure 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 STATE BUND Policy Number W-5734291
_ I certify that, in.the,performance of the work,for which this permit is issued, 1 shall not employ any
person imeny.mannerso:as to become subject to.the workers' compensation laws of California,
nd.agree that, if I.should become subject.to the workers' compensation provisions of Section
3700 of the Labor ode, I shall forthwith comply with titQpejMovisions.
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 (9100;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 fora permit subject to the
conditions,andrestrictions 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, andrthe applicant, each agrees to, and shall defend,Andemnify and hold harmless theCity
of Le Ouirna,Jts 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 vokflf 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of.t/hiss county to enter upon the ve=mentioned property for inspection purp
0991vi— `\ 1— ' nature (Applicant.or Agent
Application Number . . . . . 05-0.0004863
Permit'
. ELEC-MISCELLANEOUS
al
Additiondesc .
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . .
.
Valuation . . .
. 0
Expiration Date .
. .4/30/06
Qty Unit Charge Per
Extension
BASE,
FEE
15.0 0
1.00 15.0000 EA ELEC
TEMPORARY POWER POLE
15,.00
Special Notes and
------------------------------------------------------
Comments
TEMP 001-4 POLE'
Fee summary
Charged
Paid Credited
Due
.Permit Fee Total
----------- ----------
30.00
---------- ----------
.00 .00
3,0.00
Plan Check Total
.00
.00 .00
:00
Grand Total
30.00
.00 .00
30.00
LQPEBMIT
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do
4
70
Perndr #
Project.Addrew.
City of La Quinta
eSafew Dwsw
P.O .Bear 1504, 78-4PS Calk Tampico
/a Qdntk CA 92253 - (760) 777-7012
BLiiding Permit Appiicadon and Tracking Sheet
's lame: �.
A. P. Number
!,So mon:
Cita. ST. Zip:
Catnact
Addt=
�� �
Projetx
Cm•. ST. Tip:
-
State Lie. p :
Arch_ Engr Designer:
Cita Lie. n:
Addriess:
Cit}. ST. Zip:
Telephone
Cot»ttetion T�•pe: Occuitaatn•:
Project type icircle one): New Add'n Ater Repair Demo
State Lic i=:
Name of Cotttact Person:Sq..Ft.:
x Sc
Units
Telephonef+ of Contact Person:
imated Value of Pra"
a Submittal Req'd
.APPLICANT: DO NOT WRITE'SM.OW THIS UNE
Reed TRACiatiC PERMIT FEES
Plan Sets
Pian Check submitted
Item'
Amount
Structural Coles.
Reviewed. ready for co.. eetioas
Plan Cheek Deposit
Truss Calix
Called Contact Person
Plan Check Balance
Tide 2A CRIM
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
X" Review. ready for eorreetionsrissue
Electrical
Subeootstaor Lst
Catled'Cootaet Person
Plumbing
Grant Deed
Plans picked up
Sma.
H.O.A. Approval
Mas resubmitted
Grading
M HOUSE:-
s"' Review. ready for eorreetionsrissue
Developer impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appy
Date of permit issue
School Fees
Total'PermitFees