12-1316 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
0,0001 6
5755:6 SALIDA DEL SOL
762-240-014-55 -34243 -
ELECTRICAL
RL AG/EQ-OVERLAY
2500
Applicant:
hereby affirm,under penalty of per
Section -7060) of Division 3 of the I
License lass 1B
ate: , t' `� (L ontraotor: -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner: AV CONSTRUCTION, LL71965 HIGHWAY 111 Siff;RANCHO MIRAGE, CA 9
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Nov 1:0 2012
t ..
Date: 11/06/12
Contractor:.. F!A/qFC QU1� %
Architect or Engineer: ALTA VERDE BUILDERS, INC. FOES%
71905 HIGHWAY 111, SUITE G -- .
RANCHO= MIRAGE,. CA 92270••.
n ('7,60).776-•1.111''
Lica No.: 969219 .
LICENSED CONTRACTOR'S DECLARATION WORKER'S.COMPENSATION DECLARATION
tat I a,m licensed underprovisio_n of Chapter 9 (commencing with I hereby affirm under penalty of perjury one otthe following declarations: -
!ss and'Professionals Code; a "m license is in full force and effect. I have and will,maintain a certificate of consent to self -insure for workers' compensation, as provided
Lic s - • 9 -9219 - • for by Section 3700 of the Labor Code for the performance of the work for=which this permit is
issued .. �•`..
have.and will maintainworkers.! compensation insurance, as required by Section 3700'of the Labor
• 'Code, for the performance of1he work:for' which this permit is issued. My workers' compensation -
s OWNER -BUILD ECLARATIO - insurance carrier. and policy numtier are c
I hereby affirm under penalty of perjury that am/exempt fr -the Contractor's S to License Law for 1. ` -
' the -
following reason (Sec. 7031.5, BusineAain Professions C oec Any. city or count that requires'a.permit to
const uct,. alter, improve; demolish, or repair any'structure, `or to its issuance,, o requires the applicant for the
permrt;to'file a•signed statement that he or'she is.license, pursu _ e' ions of the Contractor's State,
License Law (Chapter,9i(c`ommencing 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 I e'applicantto:a civil penalty of not than five hundred dollars 155001.:
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 town 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 property„ain 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
puisuant to the Contractors' State License Law.).
(_) 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 for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
-Carrier STATE -FUND •.Pohcy„Number ;•9006140
certify that, in the' forniancebfthe work'for.whichthis permit is issuedrrshall notemploy any
person in any mann so as to become subject to the work • s' compensation laws of California,
and agree _that, 'if I Id become subjecumthe workers' c pensation provisions of Section
'3700 of the Labor a shall forthwith complfwith those oyisions. -
WARNING: FAILURE TO SECURE WORKE)EALTIES
'-COMPENSATION CO ERAGE IS LAWFUL, AND;SHALL
SUBJECT' AN'EMPLOYERTO CRIMINAL P -AND CIVIL FI S UP TO O-HUNDRED,THOUSAND
DOLLARS ($100,000). -IN ADDITION TOE,COST,OF COMPENS TION;DA GES'AS PROVIDED FOR IN
SECTION 3766 OF THE LABOR.CODE, INREST, AND ATTORNEY'S
i - APPUCANT'ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose beliaifthis application is made, each person atwhoserequesUand 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
performedunderor following issuance"purposes.
it.
2. Any permit issued as a result of this apcomes null and void if work is not commenced
within 180 days from date of issuancrmit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tve information is correcv,_ agree to comply with all
city and unty ordinances and state laws relating tonstruction, and hereby" the 'ze representatives
of t is co my t enter up n the above-mentioned pinspection purposes.ate: 4 nature (Applicant or Agent)
__ 1
Application Number . . . . . 12-00001316
Permit . . . ELEC-TEMPORARY POWER
Additional desc . .
Permit Fee . . . . 105.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 5/05/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE
15.00
10.00 7.5000 EA ELEC TEMP SUB POLE
75.00
----------------------------------------------------------------------------
Special Notes and Comments
TEMP POWER FOR CONSTRUCTION,. ALTA VERDE
CORAL MOUNTAIN: 1 POWER POLE, 10
SUB -POLES & 5 SPAN POLES. 2010 CODES
--------------------------------------`---------------------------------_----
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 105.00 .00 .00
105.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 106.00 .00 00
106.00
LQPE(N11T
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Cray of La Qurnta
- Bu!(dfng 8i Safety Dttrislan,
P O l3ox ISO4, 78-495 Calle Tampico:
La Quints, CA92253 - (760} 777 TOt2
Burldmg P It Applrcatronand TraekingSFleet
Permlt #
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UC �A' , Owner's Name
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APPLICANT: D0. 40T W LOW'THIS LINE
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