06-2759 (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: 7/26/06
Application Number: (7`0-6-00002759 Owner:
Property Address: 46800 WASHINGTON ST WASHINGTON 111 LTD
APN: 643-020-999-2 -30903 - C/O JACK TARR
Application description: ELECTRICAL 30240 RANCHO VIEJO R%
S
Property Zoning: REGIONAL COMMERCIAL SAN JUAN CAPISTRAN0, CA 75 6
Application valuation: 1500
Contractor: JUL 262006
Applicant: Architect or Engineer: W L BUTLER CONSTRUCTION, N .
7 GOODYEAR CIfVOFLAQUINTA
IRtrT.NE, CA 92618 FIldAWCEDEPT.
\ / (949)587-2206
a ( Lica No.': 355353
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION '
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 s: B license No.: 355353 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate:. - ontractor. �, 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 A.BD INS Policy Number 7 012012701
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the a ormance of the work for whi 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 man so as to become subjec 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 sho become subs workers' compensation' provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - % 3700 of th abor Code, 1 11 1 it
ith 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 (5500).:
1 _ 1 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 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:
Lender's Address: Pr
LQPERAIIT
W,4ING: FAILURE TO SECURE WORKERS' CO)dfpEfiNQTION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES NO IL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE OS OF CO ENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, NO ATTO EY'S FEES.
. IMPORTANT Application is hereby made to the DirectX of Buildin and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this applicatio mad , each person at whose request and for
whose benefit work is performed under or pursuan 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 w rk for 180 days will subject
permit to cancellation.
I certify that I have read this applicatio nd state that the abo infor ion i rect. I agree to comply with all
city and coun ordifPP�ances and st aws relating to building cd tructio ereby authorize representatives
of this co J epfer upon t above mentioned property for ins on pu ses. /
Application Number . . - . . 06-00002759
Permit . . . ELEC-TEMPORARY POWER
Additional desc .
Permit Fee . . . - 60.00
Plan Check Fee
00
Issue Date . . . .
Valuation
0
Expiration Date 1/22/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 15.0000 EA ELEC
TEMPORARY POWER POLE
15.00
4.00 7.5000 EA ELEC
TEMP SUB POLE
30.00
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Special Notes and Comments
TEMP POWER POLE & 4 SUB -POLES
Fee summary Charged
Paid .Credited
Due
Permit Fee Total 60.00
.00 .00
60.00
Plan Check Total 00
.00 .00
.00
Grand Total 60:00
.00 .00
60.00