07-2222 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00002222
Property Address:
81830 EAGLE CLAW DR
APN:
764-280-999-35 -300235-
Application description:
ELECTRICAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
200
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penattyof perjury that 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals'Code, and my License is in full force,and effect.
LicenseClass: License No.:
Date:, Contractor:
OWNER -BUILDER DECLARATION
1 hereby -affirm under penalty°oUperjury that I -am exempt from the Contractor's State: License Law for the
following reason (Sec. 7631 .5, Business and Professions. Code: Any city or county that requiresea permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicantfor the
permit to file.a signed statement that he or she is licensed.pursuant to theprovisions of the Contractor's State
LicenseLaw(Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code) or
that he or she is exempt therefromand the basis:for the alleged exemption. Any violation of'Section 7031.5 by _
any applicant for a permit subjects.theapplicant,to a civil penalty of not more than five hundred dollars ($500)•:
(_) 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 buildsorimproves 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. improvernent'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 ) 1, asowner of the property, am exclusively contracting with licensed contractors to. construct the project (Sec.
7044, Business'and Professions Code: The Contractors' State License Lew does not apply to are owner of
property who builds or improves thereon, and who contracts for the.projects with a contractor(s) licensed
purivant to the Contractors' State License Law:). a
(_ 1 I am,exempt under Sec. ,'B.&P.C. for this reason 'Il
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury thatthere is a construction lendingagencyfor theperformance of the
work for which this permit is issued (Sec. '3097, Civ. C':).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/02/07
Owner:
PAUL & MARY KROLL W::AU6
81830 EAGLE CLAW D
LA QUINTA, CA 9225( 02'e�00�
Contractor: CI OF LA
Owner FINANCE
------------
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 forwhich this permit is issued. My workers' compensation
insuranceXarrier and policy number..are:
Carrier - - - - - - -- - - - - - - - - =- - - - -- Policy Number
Icertifythat; in the performance of the work for which thispermitis-issued,I shall not employ any
person in any mannerso as to become subject to the workers' compensation laws of California,
and agree that, if I should.become.subje the workers' compensation provisions:of Section
3700 of the Labor Co I shall forthw' omply'with those. provisions..
Date: 2 Applics
WARNING: FAILURE To SECURE WORKERS' COMPENSATION RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALPENALTIES 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.
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 Ibehalf this application is made; each person,at'whose request and for
whose benefit work is performed�underor 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 Quina, 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 isnot 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 thisapplicationand state that the above information is correct. I.agree to comply with all
city and county ordinances and•state laws relating to building construction, aN hereby authorize. representatives
of this county to enter upon the above-mentioned pro�y�forriinspe p byes.
Date:,, �6� Signature (Applicant or Ageek/,j4_
Application Number . . . . . 07-00002222
Permit . .
. ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . .
. 26.00
Plan Check
Fee
6.50
Issue Date . . .
.
Valuation_
. . .
. 200
Expiration Date
1/29/08
Qty Unit. Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
EA ELEC MISC
11.00
----- ----"- -----------------------------
Special Notes and
Comments
---------------
----
- - --
ADDING 220 AC CRKT
FOR FUTURE SPA
INSTALL
Fee summary
Charged Paid
Credited
Due
------------------
Permit Fee Total
---------- -- --
26.00
- ----------
.00
----------
.00
26.00
Plan Check Total
6.50
.00
00
6.50
Grand Total
32.50
.00
.00
32.50
LQrERMrr
Bi" #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking, Sheet
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Permit #
Project Address: 0 "' ^� �p
Owner's Name: a,
A. P. Number:
Address: b2
Legal Description:
Contractor: dh2�'r
Address:
City, ST,,Zip:LA Q(41AJ(^� f ZZ Y3
Telephone:
Project Description: stao -n_
City, ST, Zip:
m 514—
Telephone:
State Lic. # : City Lic.. #:
--
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # St , es: # Units:
Telephone# of Contact Person.:
Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACK NG .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Energy C.alcs.
Plans ticked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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:
''" 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
Irc _54
14r�
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOI u
H--r—�OR A SCHEDULED
INSPEC
ON.
EXCEPTIONS!
CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
S Lp"5
FORr--
: d
Construction is t�C
M
(
.�—Ne,�s a .�
Dr. Martin Luther Ding Jr. Day
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1y,
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT,
S Lp"5
FORr--
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Construction is t�C
on the following de Holidays:
.�—Ne,�s a .�
Dr. Martin Luther Ding Jr. Day
President's Day
v0 -
Memorial Day
Independence Day
Labor DaY
Q,
Veteran's DaY
ThanksgiVing Day
Christmas Day
t,IVT'
TELEPHONE (760) 777-7012 FAX (760) 777-7011
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
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 maybe an employer.
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.
There may be 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 contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions..
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.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that -you, are aware of
these matters. The building permit 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: (760) 777-7011.
R'S SIG /DATE
,k� /fir �' i�►2 i? q , CA Q 22s'3
PERTY ADDRESS
PERMIT NUMBER(S)