07-1447 (ELEC)P.O. BOX 1504 4
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78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
�a
co
07-00001447
50665 VERANO DR
772-250-999-76 -30357 -
ELECTRICAL
LOW DENSITY RESIDENTIAL
1500
Architect or Engineer:
ria
------------------
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 Business a Professionals Code, and my License is in full force and effect.
License Class: B cert No.: 777699
qty
Date: • Z Z v ` Contractor:
OWNER -BUIL ER 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 1$500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure'is novintended 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 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct'the project ISec.
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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
TOLL CA V
14350 N 87TH ST #310
SCOTTSDALE, AZ 85260
(480)951-0782
Contractor:
TOLL BROS, INC.
14350 NORTH 87TH ST,
SCOTTSDALE, AZ 85260
(760)674-9699
Lic. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/15/07
310 '
MAY 2 2 2007
Circ OF iA oUly,E
— �A1.6AIPw w..—�_ _ _
WORKER'S COMPENSATION DECLARAT
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure foi workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
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 AMERICAN Policy,Number WC387821301
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 �pprkers' compensation provisions of Section
3700 of the Labor Code, I hall forthwith mply 4ith those provisions.
S 2 2.81
Date: Applicant:
WARNING: FAILURE TO SECURE 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 thorize representatives
of this county to enteruponthe above-mentioned property f inspection purpo es.
Date: 4C-2 '1 Signature (Applicant or Agent): _
Application Number
07-00001447
Permit . . .
ELEC=MISCELLANEOUS
Additional desc ...
Permit Fee
33.50
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date
11/11/07
Qty Unit Charge
Per
Extension
-
BASE -
FEE
15.00
1.00 18.5000
EA ELEC
SVC,<=600V/<=200A
18.50
Fee summary Charged
Paid Credited-
Due
Permit Fee Total
33.50
.00
.00
33.50
Check Total
.00
.00
.00
.00
_Plan
Grand Total
33.50
.00
.00
33.50
Bin #
City of La Quinta
Building a Safety Division
Pennit P.O- BOX 1504, 78-495 Calle Tampico
(� �Igg7 La Quinta, CA 92253 - (760) 777-7012
l
405 Building Permit Application and Tracking Sheet
Project Address:
4- Owner's Name:
A. P.Number. 7 - 13Y� Address: (
Legal Description: +•
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City ST Zi
Total Permit Fees
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19 ~268
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Telephone: g h
s: j 3
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Project Description:
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Arch., Engr., Designer
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Address:
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7-I99�
City, ST, Zip:
Telephone:
SO - 66S` v e scir�� 7-
Construction Type: CS; Pe wfi
State Lic. #•
paacy:
Name of Contact Person•
Project type (circle one): ew Add'n. Alter
Repair Dano
r,7 SA46 rmRr
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Pro ect:
j O tM
dt .
APPLICANT:
DO NOT WRM BELOW THIS UNE
2A7QD
#
Submittal
Req,d
Rec,d
TRACKING
Plan Sets.
PERMIT FEES
•
Plan Check submitted
Structural Calcs.
Reviewy
ed, raid for corrections
Item
Amount .
Truss Glp.
Plan Check Deposit
Called Contact Person
'
Energy Glcs.
Plans Picked. up
Plan Check Balance
Flood plain plan
Plans resubmitted
Construction
Grading.plia'
Y` Review, ready for eorrectionylssue
Mechanical
Subcon'txctor List
Called Contact Person
Electrical .
Grant Decd
Pians picked up
Plumbing
ILO A Approval
Plans resubmitted
SALL
IN HOUSE:=Grading
Review,
ready for.eorrectiousJissae
Developer Impact Fee
Planning Approval
Called .Contact Person
Pub. Wks. Appr
Date of permit Issue
A.I.P.P.
School Fees
Total Permit Fees