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05-3266 (ELEC)I P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,i,CALIFORNIA 92253 Application Number: 05-00.0:03266_, Property Address: APN: Application description: Property Zoning: Application valuation: Appli 46044 ROUDEL LN 649-040-007-17 -31816 - ELECTRICAL MEDIUM DENSITY RES 0 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: LA QUINTA NORTH PARTNERS LP 2 CROOKED STICK DR NEWPORT BEACH, CA 92660 (949)533-9408 Contractor: or Engineer: URBAN HABITAT 2 CROOKED STICK DRIVE NEWPORT BEACH, CA 92660 '(949)759-1018 Lic. No.: 808912 -VI ---------------- --------- LICENSED CONTRACTOR'S DECLARATION. 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 Busines ,and Professionals Code, and my License is in full force and effect. Lic e -Class: B License No.: 808912 ' 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. 7031.5, 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).: (_ 1 I, as owner of the property, or my employees with wagesas 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 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.). (_) 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 toan owner of -"property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractois' 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 forthe performance of the work for which this permit is issued (Sec. 3097, Civ. C.). " Lender's Name: - Lender's Address: LQPERN1IT VOICE (760) 777-7012 FAX (760) 777 -7011 - INSPECTIONS (760) 777-7153 Date: 7/28/05 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION 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 STATE FUND Policy Number 1741937-2005 I certify that, in the performance of the work for which this permit is issued, I 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 3700 ofjhe Labor Code, I shall t=hwith comply with those provisions. . ' Dat���i�f Applican WARNING: FAILURE TO SEC RKERS' 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 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 t uilding construction, and hereby authorize representatives 'ofth' county to enter upon the above-mentioned ro ert fo ' ,coon purposes. -3-U rr , __ ._ Date:_ Signature (Applicant or Age r_.. _ .— -- -- _ LQPERMIT Application Number . . . . . 05-00003266 Permit . . . . . . ELEC-TEMPORARY POWER Additional desc . Permit Fee 135.00 -'Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration•Date 1/24/06 Qty Unit Charge Per .'Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 14:00 7:5000 EA ELEC TEMP SUB POLE 105.00 Special. Notes and Comments TEMP POWER POLES & 14 SUB.POLES. Fee summary Charged Paid Credited Due - -- -------- --------- ---------- Permit Fee Total 135.00 ------ .00 .00 135.00 Plan Check Total .00 .00 .00 .00 �- Grand.Total 135.00 .00 .00 135.00 LQPERMIT