06-1191 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
�LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation: .
r, Applicant:
4h
yA 6-:- 0_00_0 11.9 1=:*
80404 OLD RANCH TR S
762-240-999-68 -30834 -
ELECTRICAL
LOW DENSITY RESIDENTIAL
250
Architect or Engineer:
�F �4ur�rw
BUILDING & SAFETY DEPARTMENT
BUILDING.PERMIT
Owner:
TOLL BROTHERS
73121 FRED WARING # 100
%ALM DESERT, CA 92261
LICENSEDCONTRACTOR'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 Business and Professionals Code, and my License is in full force and effect.
License Class:: 13 Li cen No.: 77769.9
DJ ate:' "•L J_� Con OC
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 acivil penalty of not more than five hundred dollars 155001.:
(_ 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 (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.).
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:
7
LQPERMIT •.
actor:
.BROS, INC.
0 NORTH 87TH ST, STE #310
TSDALE, AZ 85260
(760)674-9699
LiC. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/23/06
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
insurance carrier and policy number are:
Carrier ZURICH INS Policy Number WC387821300
_ 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
2 3700 of the Labor Code, I halt forthwith comph those provisions.-
___ J �Z Applicant:'
WARNING: FAILURE TO SECURE WORKERS' C04PENSAT16N 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.
f
APPLICANT ACKNOWLEDGEMENT r
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 1 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-mentionedproperty for' spection purp
ignature*(Applicant or A&
Application Number . . . . . 06-000011.91
Permit ELEC -TEMPORARY POWER
Additional desc .
Permit Fee 52.50
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date 9/19/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00..
1.00 15.0000 EA ELEC
TEMPORARY POWER POLE
15.00
3.00 7.50.00 EA ELEC
TEMP'SUB POLE
22.50
Special Notes and Comments.
--------------
TEMP POWER POLE WITH 3 SUB.POLES
FOR _
STONE CREEK RANCH
"Fee summary Charged
Paid• Credited
Due
r� •---------------------------`----------
--------------------
Permit Fee Total 52.50
.00 .00
52.50
Plan Check Total .00
.00 .00
.00
Grand Total 52.50
.00 .00
52.50
Bin #
City 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:
Owner's Name: O 44
A. P. Number:
Address: 73- 12 l J!md Wrtr4 Sv#Ae- i0p
Legal Description:
Contractor: T'd �11 ts co
Address:
City, ST, Zip:
Telephone 7bo
Project Description:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Constrgction Type: Occupancy:
State Lic. #:
Project type (circle one) New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
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 resubmitted
Mechanical
Grading, plan
2nd Review, ready for corrections/issue
Electrical 721V#
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 Impact Fee/
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
{.