05-4395 (ELEC)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:05-00004395"'",
Property Address:
79738 PARKWAY .ESPLANADE
APN:
609-590-033- -
Application description:
ELECTRICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
500
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PONDEROSA HOMES II, LLC
400 S. FARRELL DRIVE, B103
PALM SPRINGS, CA 92264
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/29/05
Contractor:
Applicant: Architect or Engineer: .O PONDEROSA HOMES I I , INC.
6671 OWENS DRIVE
OCT 0 3 2005 PLEASANTON, CA 94588-
�II ► (760)318-7710
CITY OF LA QUINTA Lic. No.: 752884
FINANCE DEPYgo/T
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LICENSED.CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION j
I hereby affirm under penalty of perjury that I am licensed under :provisions of Chapter 9 (commencing with I hereby affirm undei 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 toself-insurefor workers' compensation, as provided
License Class: B -- Li o se No.: 752884 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
J issued.'
ate: i� Q Contractor: 1111have 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 TANNER INSUR _ Policy Number 15671603 -
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 its issuance, 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 should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or Q 700 of the Labor C,o e,'I shall f hwith t•om I with those provisions.
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):; D �, scant: �•�l ��
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation,.wil1 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 CRIMINALPENALTIES 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 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 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
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
of La Quints, its officers, agents and employees for any act or omission related to the work tieing
performed under or following issuance of this permit.
2. Any permit issued as a result of this applicationbecomes 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 authorize representatives
of this count t )enter upon the above-mentioned propor):y for inspe i
aD te: 3 U J Sig re (Applicant or. Agent): /n/
Vii►
Application Number . . . . . 05-00004395
Permit . .
. ELEC-MISCELLANEOUS
Additional desc .
.
Permit Fee . . .
. 30.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
3/28/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 15.0000 EA ELEC
TEMPORARY POWER POLE
15.00
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Special Notes and
Comments
TEMP POWER POLE
Fee summary
-----------------
Charged
----------
Paid Credited
Due
Permit Fee Total
----------
30.00
--------------------
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Grand Total
30.00
.00 .00
30.00
LQPERMU