06-1483 (ELEC)P:O. BOX 1504 �^� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777=7153
'BUILDING PERMIT
Date: .4/11/06
`Application Number: 06-00001483" Owner.,
- _ Property Address: 51985 AVENIDA VALLEJO TRUJILLO PAUL D
APN: 773-171-024-12 -000000- d P O BOX 1455
Application description: ELECTRICAL ��-- f LA QUINTA, CA 92253
Property Zoning:.. COVE RESIDENTIAL I
Application valuation: 250. APR 1 2 1006
CITY OF Contractor: 1J
Applicant: Architect or EnginE DEPT. Owner
-------------------------------
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 I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of 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 for which this 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 the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to itsIssuance, also requires the applicant for the person in any manner so as to become subject to the workers' 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 s ecome subject to the %V$kers' compensation provisions of Section y'
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or // 3700 of the Labor o shall forth' comply) ith those pro ' s.
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).: Date: II D Applicant:
as owner of -the property, or my employees with wages as their sole compensation, will do the work, and - s -
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAI 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 ^
I _ 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 Code: 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,
1 _ I I am exempt under Sec. 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-
•• �` I' 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 l have read this application and state that the•above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to buildi construction, and her9nauthorize r resentatives
of this county to enter upon the above-mentioned prop or inspectio rposes /J r. .
Lender's Name: - - _ - - i '
' Dao-7//� �� Signature (Applicant or. Agent):
Lender's Address:
LQPERMTT - .
Application Number
06:-00001483
Permit-'
ELEC-SERVICE
CHANGE
Additional,desc .
Permit Fee
33.50
Plan Check
Fee
00
Issue -Date
Valuation
0
:
,. Expiration Date
10/.08/06
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
x
.,Perm
33.50' -------.00
-------:00
-----33.50''
33.50'
Plan Check Total
:00
00
00
Grand Total,:"
33.50
.00
.06
.00
33.50
LQYERMIT
,r
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: VL7 vo 11-4-4> .
A. P. Number:
Address:
Legal Description:
Contractor: d
City, S.I., Zip: v I �0 1. Z!�
7190 l# bz r i—�•/(
Telephone: u v'r " 'C]
Address:"
,Project Description: �F:GU
City, ST, Zip:
Telephone:
State Lie. #ell
:
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: 2 5 D
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING .
PERMIT FEES"
Plan Sets
Plan Check.submitted
Item
Amount
Structural Calcs.
Reviewed; ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
4.
Plan Check Balance
Energy Calcs.
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 correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
l
TELEPHONE (760) 777-7012 FAX (760) 777-70.11 _ ` r
R5
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property r
improvements specified.
For your protection you should be, aware that -as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to -be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, 'with the exception of various trades that you plan to subcontract, you should, be
aware of the following information' for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors'!or
subcontractors, then you may be an employer. it
If you are an employer, you must register with the State and Federal .Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security. taxes, .worker's
compensation insurance, disability insurance costs and unemployment compensation contributions. l
There maybe financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and; if.
you wish, the U.S.. Small Business Administration). For more specific information about your obligations under' State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions. X i'
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building .
permit, 'erroneously implying that. the property owner is providing his or her, own labor: and material personally.
Building permits are not required to be signed by property owners unless they are performing -their own work
personally.
' 1
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form sd'that a can confirm that you are aware of
these. matters. Thebuildingpermit will not be issued until the verification is returned.
Very•truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012 -
FAX: (7 77-7011
OWN WS'SIGNATURE/DAT9. gst"V
PROPERTY AD
O i' •r
PERMIT NUMBER(S)
i