04-3718 (ELEC)I�
QRh(rC4V
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
APR. ----------.
• li er '� 04-00003718 ,,
Zt?B*. . . . .Date
4/27/04
Add s . . . . 49720 RANCHO SAN FELIPE
F AIC6DEprA 649-610-02.9-54 -28964 -
App l.ica d scription ELECTRICAL
Property Zoning LOW DENSITY RESIDENTIAL
..Application valuation.. 50
Owner Contractor
MURRAY MATTHEW G OWNER
477.20 RANCHO SAN FELIPE
LA- QUIN'T'A CA 92253
Permit . . . .. , . ELEC.-MISCELLANEOUS
Additional.desc
Permit Fee 15.75... Plan Check Fee..
.3.94
Issue Date . . . . Valuation
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
•1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
Special Notes and Comments
ADD DEDICATED CIRCUIT FOR EVAPORATIVE
COOLER.
Fee summary Charged Paid. Credited
Due
Permit Fee Total 15.75" 00 00'" "' ..
.• 15:75 ,
Plan Check Tdtal. 3.94 - %00 .010
3.•94
Grand Total 19.69 .00 .00
19.69
P.O. BOX 1504 a l�G��
7E-495 CALLE TAM►ICO VOICE (760) 777.7011
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-70144a1
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Of— 3?/ g Date: Z! ty
Applicant: 1-fa4, Architect or Engineer
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No..
ovnwfnu rt:KMI I UtcLARATIONS
LICENSED CONTRACTOR'S DECLARATION
Codeode.. and my lb in full tome and effect
I a affirm ceder penally d perjury that I am licensed under proMMS d Chapbr 9 (eommerhdnp with Sscbn 7000) d Division 3 d the Business and Prolammm ets
icense
License Class license No.
Dab - Corhtractor
1 hereby affrm under penalty d perjury to I am OWNERS DECLARATION
�y or county that �s a pemrtil b � irorrh to Contractors' State Ltoahce law for the following mason (Sec 7031 6. Business and Professions Cods. Any
stalemert int he or she lsficeraad ' knpore. dish or repair any sit U Mre, prior b lts issuarhca, also requires the applicant for the Pe mit b iia a sigro0
and Professions Code) or that he or b to v�ons d the Contractors' State Lioenee Law Poplar 9 (commancing with Section 7000) d Division 3 d to Business
>jhq,appieant b a dvi •� therefrom and the basis for ire staged ehcamhption Any viotation d Section 7031.5 M any appicart br a permit subjects
(� Ply d not more inn the hundred rioters (i5oo).):
1. as owner d the property. or my employees with wages as Coir sob oomperMGM wi do to work, and to structure Is not Irtenhded or offered for sale (Sec 7p4.
Business andher Prf or through
irou; Code: Ths Contractors' stab License Law doe: not apply b an owner d property who builds or improves thereon, and who does to worts
withimself �iin o his or Mr own employees. govided that the iepoovemenfs aro not Intended or offered for sale. a. however. the briding or improvement is
sol(..) I. as d wit a on 1� ofPropertcompletion, the owrw4xdda wN have the burden d pmvw g that he or she did not build or improve for the purpose a sob.).
Stab LW" Low does nnot contracting of
pe ith likened contractors b construct to project (Sec. 7044. Business and Professions Code: The Catnadors'
apply b an owner d property
the Contractors' stab linxr,>;e Law.). who bunds or inproves the wk and who contracts for the projects with a contracbr(s) icensed pursuantlo
U lam sec . SA P.C. tis
Date owner
firm under ' COMPENSATION DECLARATION
Ply d perjury one d to fotowinp died r,tiors
1 hereby affirm .
_ 1 have and will maintain a cWbk*e Of consent to self4 erre for workers• cor pensation, as provided for by Section 3700 d the Labor Code. for rue pertomhsnoe
d the work for which this pen, is issued
I have and will maintain workers' eomperhsation pnuranoe. as required by Section 3700 d the Labor Code. for to Womonce of the work for which this per" Is
Carrierissued f ry workers• canpensabon irks xwce artier and policy nunber ane:
. op _Policy Number
I eerily int. in the performancft d Mn work for which this penmre is iswed. l stall not employ any person in any manner so as to become unbject b to workers'
IF "Man o with thousCallomis' and agree that, tf 1 shhculd become subjed b to workers'
=nplycompensation provisions d section 6700 of to Labor Code. I shall
Date v(
ApPiantig
WARML I" TO SECUREW" C IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER To CRMNAL PENALTIES AND
SEC FINES 5 F ONE LABOR
CHUNDRED E. Rn
W DOLLARS (=100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, M EREST. AND ATTORNEYS FEES. .
I hereby affirm urda penally of CONSTRUCTION LENDING AGENCY
perjhry that tare is a corstudion landing agency br to performance d the work for which Itis pen. is issued (Sec. 3097. Civ. C.).
Lender's Name
Lenders Address
]�!
IMPORTANT Application fshereby made 10 the Director BWdAPPLICANT ACKNOWLEDGEMENT
1. Each person upon whose beint(tti: app�atiof d MW Safety for a permit subject b the conditions and restrictions set forth on Oils appigGon.
on is made. each Person at whose request and for whose benefit works pursuant berry pem*
Issued as a result d this appicaion, the owner. and the applicant. each peed whda a
cfk0m- agents and employees for any ad or omission retabd b the wow to' and cede, under
or allowin i and hold harmless ess the Gly d V Duthie. Its
2 Any permit Issued as ation tI work br a result ad f# application becomes null and void 9 work is not commenced whNnf d lssuance d Itis D� � or
ces1 certify that 1 have read itis days subject pe�hat #10 and b cencellaG°n. dnlYa from dale d issuance d such
and as application
tion representatives stat et at this above Irtom abort is correct 1 agree b comply with all city and county ordinances. and state taws relating b building
Oft above -m ntiwmed property for inspection purposes -
Date Sigrathre (Appficamt a
�+
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more.for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer -and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do riot carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 77%%- 012
FAX (GW 711 1
�W]NI�R'S SIGNA 7DATE
17 -2ZO 1 l .nV6� Si4N
PROPERTY ADDRESS
-71 �
PERMIT NUMBER(s)