06-1167 (ELEC)P.O. BOX 1504 VOICE (760) 777-7012
t 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760),777-7153,
BUILDING PERMIT
Date: 3/22/06_
Application Number: 06-00001167- Owner:
Property Address: 78743 AVENIDA TUJUNGA HERNANDEZ RAMIRO •,
APN:. 770-093-004-27 -000000- *NOT ON FILE
Application description: ELECTRICAL UNKNOWN, CA 99999
Property Zoning: LOW DENSITY RESIDENTIAL --- - - - - - - - - - - ------=------ - - - - --
Application valuation: 0
Contractor: D A
Applicant: Architect or Engineer: Owner
MAR 221006
-----------------------------Ow®FuQUINTA
LICENSED CONTRACTOR'S DECLARATION - - - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with 1 hereby affirm under penalty of perjury one of the following declarations:.
Section 7000) of Division 3of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.: - for by Section 3700 of the Labor Code, for the performance of the work forwhichthis permit is
issued. "
Date: Contractor: _ 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
OWNER -BUILDER DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - Policy Number --
following reason (Sec. 7031 .5, Business and Professions' Code: Any city or county that requires a permit to I certify that, in the performance of theworkfor which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires theapplicant for the person in any manner.so as to become subject to thIwo ers' compensation laws of California,.permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Co I shall forthwith complyse provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - -
an� a Ocant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: - Dater 2Z b` Applicant:
( m__ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL. -
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself. through his or her own employees, provided that the. _ DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
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.). - APPLICANT ACKNOWLEDGEMENT -
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Coder The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with.a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for -
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit.issued as a result of this application,
(_) I am exempt under Sec. - , B.&P.C: for this reason 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.
~Date: Owner: 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'
CONSTRUCTION LENDING AGENCY .. , permit to cancellation. '
I hereby affirm under penalty of perjury that there is a construction lending agency -for the performance of the I certify that I have read this application and state that the above information is c"yauth?orize
with allwork for which this permit is issued (Sec. 3097, Civ. C.I. - city and county ordinances and state laws relating to building construction, and tivesof this county to enter upon the above-mentioned prop r inspection purpos
Lender's Name:') .Date: � h Signature (Applicant or Agent): 04Lender's Address:
LQPERMIT
Application Number 06-00001167 Y
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Permit, ELEC-SERVICE CHANGE'
-
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' Additional. desc
Permit Fee ..'. '33.50 Plan Check Fee
00 7
'
Issue Date . . - Valuation
0' '
Expiration Date 9/18/06'
„-
' Qty Unit Charge.Per •i -
Extension
BASE FEE
15.00
'
1:00 18.5000 EA ELEC -SVC <=600V/<=200A
18.50 s
• i
-
Special'Notes and Comments
r ELECTRICAL CHANGE'OUT AND RE -LOCATION
,
„
OF•METER PANEL 200 AMP.SERVICE ,
♦
; - ..
- Fee summary Charged Paid _Credited
Due _ -
---
------- --
Permit Fee Total 33.50 00 .00
33.50 '
Plan Check Total' .00 .00 .:0.0
00
Grand .Total' 33.5000 :•:00
33:50
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-LQPERMIT
CITY OF LA QUINTA 'SUB -CONT CTOR LI
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JOB ADDRESS 73-730's
72,_ J
BUILDER DD:1
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This form shall be hosted on the job ith the Building Inspection Card at'all'times in a conspicuous place. Only persons appearing on`this list or.their employees are.authorized'to work,
work. Failure to will resulvin a stoppage of work.and%or the voidance
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on this job. An' changes
-to this list must -tie approved'by
the Building Division prior to commencement of comply
of building permit.' For each 'applicable -trade, ali information `requested below must be completed
by applicant. "On' File"' is not an acceptable response.
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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 #
66 -
Project Address: 3 v 4
Owner's Name:
A. P. Number:
Address: ?69;7— el-? (/ —Ft),
Legal Description:
City, ST, Zip:
Contractor:
Telephone: 7 6 -?7 7-19 4 6
Address:
Project Description: �- 0 G� ►2 .
City, ST, Zip:
Ir Ut -e— km
Telephone:
State Lie. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: �4U
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
T'RACIMG
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 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2nd 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:-
7rd 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
J
1 �