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10-1130 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10700001i;0� Property Address: -" 52805 HUMBOLDT BLVD APN. 767 -880 -015 - Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation- 500 Applicant: Architect or Engineer: .BUILDING &SAFETY DEPARTMENT BUILDING PERMIT -----------------7-------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am Iii c ed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr sionals Code, and my License is in full force and effect. L'' i nseClass: B Licens o.: 915336 Date:..4'Z9 ince tractor: OWN -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exer t from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professi s Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any stru ture, 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 (5500).: (_) 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.). (_) 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.). (_ 1 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: la - Lender's Address: I;QPERMIT VOICE (760) 777-7012 -FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/28/10 Owner: EAST OF MADISON LLC PO BOX 1482 A LA QUINTA, CA 92247 Contractor: 1�0 V•d,�1 DBCA INCA P:O. BOX 1482 LA QUINTA, CA 92247 (760)393-5271 . Lic. No.: 915336 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 TRAVELERS PROP Policy Number YEUB282D779708 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so1as become subject to the workers' compensation laws of California, and agree that, if I shoulN b om su- ct to the workers' compensation provisions of Section 3700 of the Labor Codel I all f rthwith mply with those provisions. WARNING: FAILURE TO SECURE WORKE ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION T- E 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 abov i rmation is correct. I agree to comply with all city and county ordinances a d state laws relating to building c t ution, d hereby authorize representatives of is/(county t10 enter u the above-mentioned property for i on purpos Date: v r{ V Signature (Applicant or Age LQPERMIT Application Number 10-00001130 Permit E_LEC-TEMPORARY POWER Additional desc . Permit Fee 30.00 _ 'Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 4/26/11 Qty Unit Charge Per Extension. BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY.POWER POLE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments TEMP POWER POLE FOR NEW CONSTRUCTION. 2007 CODES. --_---------------_-------------------------------------- Other Fees . . . . ... BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 30.00 .00 .00 30.00 Plan Check Total ..00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT Bin # City of La Quints Building 8r Safety DWon Permit # P.O. Box I SO4, 78-49S Calle Tampico p ` La Quina, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Shee r Q _ g t Project Address: �jZB a CZ�pO`� ,7 14 70'wne7r'sNa=me.-A. P. NumberSOQ�iS *�-5G «n: Zip: ZX UTAII 1 4/1 ?W5 3 Contractor 040e4. Telepltorie: �Oo z 9Zo %/B 3 Address: , 5'2 1rojca Descriptioit: city. ST, zip: Telopitone: / el -16: State Lic. #: City Lia #z Arch.. . Designer Al �I Ad4ress: ` ��r v V. 0T, X -4p: 4'Pr UjiUIft - ! 5'Z805 til ?CL Telephone: '16p 5�4-.4747 Construdion type: Occupancy - State cy-State Ltg. #: . Projed type (circle one): New Add'n Alba Repair Demo Name of Contact Person: � �' rl za45 - //,^, G Sq. FL: #Stories: ti Unis: tsot Telephony # of Conlad Pen: t�(JZ l ' 1 �v 3 EWmijftd Value of Project: APPUCANT: DO NOT VVPJTE gg-OW THIS UNE # Submuw Plan Sets Structural Cafes. 'Muss Cities. Tldc 24 ales. Flood plain plan Gradtag plan Subcontactor Lint Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wlcs. Appr School Fees Rec'd Plat R. Cal Plan Plat 2_l Call Plat Plat MI Ca] Dat 11tACMG PERMIT FEES Check submitted Item Amount eared, ready for corrections Putt Check Deposit ed Contact Person Plan Cke& Balance s pitted ap Construction s resubmitted Mechanical tevkw, ready for eorrectionalutte Elewiea! ed Contac Person umbing is pickedup jGr*(Hag M.L Ls resubmitted eview,ready for eorrectiottsrtssneeveloper Impact Fee ed Contact Person A.LP.P. of permit Issue Total Permit Fees ^ ' �� ' ~~`M~ ~~ - ~°/ =� �" -- / / / ~�� 34 / / /—�� . =45 " '-`�� ' ,// ./ / 44 35 .82 MW 43 36 A 42 41 49 39 37 V. 50 THE MADISON tLUE3 51 52 Kul 45. `'- Tr4­015o *-Mae,53 . 'omemcoouE �Z!,-Ira Ao-zKiEp � 7595 ;consultants, Inc. CLUBHOUSE AND VILLAS EXHIBIT DRAWING NAME: EH -CH -VILLAS PROJECT No. 0001 MDC SHEET , OF 1