07-1741 (ELEC)4 P.O. BOX 1504 ^�
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 67--00001741 Owner:
Property Address: 79300 ROSE -DAWN SANTA ROSA DEVELOPMENT INC
APN: 649 -030 -069 -NN -31311 - 46753 ADAMS ST
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: HIGH DENSITY RESIDENTIAL (760) 771-3345
Application valuation: 500
Contractor:
Applicant: Architect or Engineer: CONSOLIDATED CONTRACTING,
46753 ADAMS STREET
LA QUINTA,. CA 92253
(760)771-3345
JP Lic- No.: 824183
cop.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/15/07
INC.
---------------------------------------------=----------------------------------------
/--------
LICENSED CONTRAC 'S DECLARATION WORKER'S COMPENSATION DECLARATION - -
I hereby affirm under penalty of perjury that I am licensed er * ovisi of hapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Profes ' n e, d icense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C8 - -c .824183 for by Section 3700 of the Labor Code, for the performance of the work for .which this permit is
issued.
,-15ate: ontractor: 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
. OWNER -BUILDS ECLARATION insurance carrier and policy number are:
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 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 a permit subjects the applicant to a civil penalty, of not more 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 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 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.).
(_ 1 I am exempt under Sec: I ; B.&P:C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERDIIT
Carrier STATE FUND Policy Number 1770749-2007
_ I certify that, in the performance of the work for w pe .t is issued, I shall not employ any
person in any manner so as to become su er compensation laws of California,
and agree that, if I should become su t or r ' ompensation provisions of Section
3700 of the Labor Code, II f h ly those provisions.
ate: plicant:
WARNING: FAILURE TO SECUREORKERS' 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.
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 personupon 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 a ill subject -
permit to cancellation.
1 certify that I have read this applicatiorrand state that the above informa c e . -I agree to co ly with all
city and county ordinances and state laws relating to building nstruc ' n er y authorize eseniatives
of this county to enter upon the bove-mentioned property sp i pos
ate: -�Ib=F Si ture (Applicant or Agent),
Application'Number 07-00001741
Permit . . . . . ELEC-MISCELLANEOUS
Additional desc —
Permit Fee 33.50
Plan Check
Fee
.00 .
Issue Date
Valuation
0
Expiration Date 12/12/07
Qty Unit Charge .Per
Extension
BASE
FEE
15.00
1-00 18.5000 EA ELEC
SVC.<=6,0.OV/<=200A-�
18_50
Special Notes and Comments
___se_
100 AMP IRRIGATION METER
Fee summary Charged
Paid Credited
Due
Permit Fee Total 33.50
.00
00
33.50
Plan Check Total .00
.00
.00
.00.
Grand Total - 33.50
.00
.00
33.50
LQPERMIT
Bin #
Ci. ty of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -. (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
\ \
Project Address:' 3OZ)AV
m�
Owner's Name: O ,�
A. P. Number: l-OL 1—o w-- cL
Address: 76
Legal Description:
City, ST, Zip: Z�.J
Contractor: if G
Telephone:
Address:.14 le 7 -t—
Project Description:'
City, ST, Zip: 225.3 �
I
Telephone: -7&077 /-'.334,5
-
State Lic. # :
City Lic. #: 7Q1qL
"IN Ai 11 13CW 11J
Arch., Engr., Designer:
Address:
q , n
City, ST, Zip Pr q zl
Telephone: D L
State Lic. #: 2
Name of Contact Person: r
Construction. Type: Occupancy:
Project type (circle one): New Adc'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: D
a®
Estimated Value of Project: Q�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs..
Plans picked up
Construction
Flood plain plan.
Plans resubmittedMechanictl
Grading, plan'
2" Review, ready for correctionsfissue
Electrical ..
Subcon6ctor List
Called Contact Person
Plumbing:
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''" Review, ready for corrections/issue.
Developed Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
.41
Total Permit Fees
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