05-0629 (ELEC)1 .44
. Taf 4
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 9.2253 INSPECTION REQUESTS (760) 777-71-53
BUILDING PERMIT
Application Number . . . .0.5-0-600062.9 Date 2/18/05
Property Address . . . . . . 45510'DEERBROOK.CIR,
APN: 604-4:05-014-32 -23995 -
Application description . . . ELECTRICAL
Property Zoning'. . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . '200
Owner Contractor
MICHAEL D HANSON LC LIGHTING & ELECTRIC INC.
45410 DEERBROOK CIRCLE 74.990 JONI DRIVE BLDG 3-C
LA QUINTA CA 9225.3 PALM.DESERT CA 92260
(760) 862-1906
WCC.: STATE FUND
WC: 465000155 10/20/05
CSLB: 850636 12/31/06
CCC: C10
Permit . . . . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 15.75 Plan Check Fee 3.94
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75
Special Notes and Comments
240 VOLT ELEC FOR POWER TO. ABOVEGROUND
SPA-
Fee summary Charged Paid Credited
Permit Fee Total 15.75 .00 .00
Plan Check Total 3.94 .00 .00
Grand Total 19.69 .00 .00
Due
15.75
3.94
19.69
t
FE3 91005ITY OF LA taU1Nr.4 I
r 419
P.O. BOx 1504ICE VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-70.11
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760.) 777-7153
BUILDING & SAFETY- DEPARTMENT
Application Number: D -s - OG Z Date: l 0J
Applicant: �f Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
WING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
Thereby affirm under penalty of perjury that l am licensed under provisions of Chapter9 (commencing with Section 7000) of Division 3 of the,Business and Professionals
Code, and my Licen,Sgisin�fuVorce and effect. �__� . � �b
se Clas's""1 CC._.. ((JJ icen eGNo. �P
�rJ OWNER -BUILDER. DECLARATION
I hereby affirm under penalty of perjury that I am exempt from'the Contractors' State License Law for the following season (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
statemenf.that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that heor she Wexempt 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 then five hundred dollars ($500):):
U 1. 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 or through his:or her own employees, provided that the Improvements are not intended or offered forsale.. 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.):
U 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 forthe projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exemptunder Sec. , B.&,P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone of the following declarations:
_ (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.perfomlance
of the work -for which this permit is issued..
_ f have and will maintain w rkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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'Carrier J7 � �' pt ( _Policy -Number_ .; -�
_ I certify that, in the performance of the work for whichthis,pennit: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 workers' compensation provisions of Section 3700 of the Labor Code, I shall
fort ,comply with those provisions, p
// � ► .f7 �i�'/ /per •t
Date iG %v �S (ApplicanC
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that.there'is a construction lending agency for the peffonnanoe of the work for which this permit is issued (Sec. 3097, Civ: C.).
Lenders Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is herebymade to the Director of Building and'Safetyfor a permit subject to the conditions and restrictions set forth on this application:
1. Each personupon 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 Cityof.La Wuinta, its,
officers,. agents and employees for any actor 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.subjsct permit.to cancellation.
I certify that I have read this application and state, that the above information iso I s qdo comply with all city and county'ordinances and state laws relating to building
constructi.on'.and hereby authorize representatives of this county to ente;- the tinned property for inspection purposes.
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