08-0375 (ELEC)Qum
TA
P.O. BOX 1504 &
78-495 CALLE TAMPICO
LA QUINTA,.CALIFORNIA 92253 BUILDING & SAFETY. DEPARTMENT,
Application Number: 08-0.0.0.00375
Property. Address: 46277 ROUDEL LN
APN: 649-040-007-D -31816 `-
Application description: ELECTRICAL
Property Zoning: MEDIUM DENSITY RES
Application valuation: 500
Applicant:` Architect or Engineer:
Y
c�
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
Owner:
LA QUINTA NORTH PARTNERS LP
2 CROOKED•STICK DR
NEWPORT BEACH, CA 92660
(949)533-9408
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
LircS9nse Class: QB License No.: 8 0 8 912
BeCe:� �'� (/ ontractor:
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 70001 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 _ 1 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 fSec.
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.).
( ) 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 is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Contractor:
URBAN HABITAT
2 CROOKED STICK DRIVE
NEWPORT BEACH,.CA 92660
(949)533-9408
Lic. No.: 808912
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
- Date: 3/03/08 .
------------------
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.
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
in carrier and policy number are:
Carrier STATE FUND Policy Number 1741937-2006
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
377/00 of th Labor Code I �h�u Forthwith comply with those provisions.
i Date�t/ _T-® `1,Applic -,.� _a
WARNING: FAILURE TO S WORKERS' 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 to building construction, and hereby authorize representatives
of this county to enter upon the above __ _ purposes.
Data!Signature (Applicant t
�� .
Application Number . . .. 0.8-00000375
Permit ELEC-MISCELLANEOUS
- Additional desc .
Permit Fee . . . 33.50
Plan Check Fee
8.38
Issue Date.
Valuation
0 .
. Expiration Date 8/30/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
Spcoial Notco and Commcnto
_
---------
100 AMP METER PEDESTAL IN RETENTION
BASIN AS PER MAP DRAWING
Fee summary Charged
Paid Credited
Due.
Permit Fee Total 33:50
.00 .00
.33.50
Plan Check Total 8.38
.00 .00
8.38
Grand Total 41.88
.00 .00
41.88
LQPERAIIT
Bin #
..City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking S.ieet
Permit #
Project Address: 44V-2-4-7— R04eP k A)
Owner's Name: 77ott,;-A Am. —P*.714 co tp
A. P. Number:
Address:
Legal Description:
City, ST, Zip: "J44-t owh— 48fao4- cos- zz 46a
Contractor: A-0 ",Aj
Telephone:
Address:'-CA.,r,0[1,-4P C,-�� bl/
Project Description:
City, ST, Zip:
Telephone,q d6--,5,3 0
..... .. ....
State Lic.#:
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ...............
.. ....................
......... . . ..
State Lic. #: ...... ........... I
...... ...........
................... .. ........
Name of Contact Person:
onstruction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories:units:
Telephone # of Contact Person:
Estimated Value of Project: d Soo
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
Rcc1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount'
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"! Review, ready for corrections/issue
Electrical
Subcontactor 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
Developer fin pact Fee
Planning Approval
Called Contact Person
A.I.P.P,
Pub. Wks. Appr
Date of permit issue
School Fees
LTotal
Permit Fees
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