04-3639 (ELEC)OOR
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O� E®�Q�• - BUILDING & SAFETY DEPARTMENT
C �� • ' 1504 �..y �., ., (760).777 -7012 -
OF
760).777-7012OFTt�-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777.-7153
BUILDING PERMIT
77
Application.Number 0.4 000036 9 -_ 1'I Date 5/11/04
Property_Address 47000 WASHINGTON ST U
APN: 643-200-016.- - -
Application description ELECTRICAL
Property Zoning COMMUNITY COMMERCIAL
Application valuation 2500
Owner Contractor
LPP INC MCDERMOTT ENTERPRISES
RANDAL MILLER P.O. BOX 163
73745 EL PASEO PALM DESERT CA 92261
PALM DESERT CA.922'60 (760) 346 -0745 -
WCC: NONE
WC: 'EXEMPT 02/28/05
CSLB: 306566 02/28/05
CCC: B
------------------------
---------------------------------------
Permit. . . BUILDING PERMIT
- t
Additional desc
Permit Fee 54.00 Plan Check Fee 35.10
Issue Date . . . Valuation . . 2500
Qty Unit Charge Per Extension
„BASE FEE , , 45 . 00
1.00 9..0000 THQU"',BLDG" 2 001--2S, 000 _ 9.00"-,,
-----------------------------------------------------------------------------
Permit . . ELEC'-SERVICE CHANGE
Additional desc
Permit Fee 15:00'. Plan Check Fee ° .00` ,
Issue Date Valuation . . . . 0
Qty Unit Charge Per Extension
BASE .FEE 15.00
Permit ELEC-MISCELLANEOUS
Additional desc
Permit Fee . . . . .-18:00 Plan Check Fee 4.50
Issue Date: Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
4.00 ".75.00 EA ELEC POLE LIGHT 3-00
P.O. Box 1504 • ��r��
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application N
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: J/ (( / Uy _
Arc ' act or Engineer:
5
Architect or Engineer's Address:
Lic. No.: - \ -�s it S '� . .
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under pro isions 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.
�ense Clais icense No.
/ Date_
Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (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
statement 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 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).):
U 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 or 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.).
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 for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' 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
I of the work for which this pernit is issued.
ty _ 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
7 issued. MyVers, compensation in ce carrier n olicy niber are -
mar 3,;,
r V l�JA/ olicy Number (. (< 3 Z vv
I certify that, in the performance of the work for which this permit is issued, I shall not any person in any manner so as to become subject to the workers'
compensation laws of California, and agr a that, if I should become subjectto workers' pensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provision _
Is
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
1 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
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 160 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 ' rect. I agree to comply with all ci nd cou ty inances and state laws relating to building
construction, and hereby authorize representatives of this county to ente n the above-mentioned party fo ns s S.
O� t
/Datd{1 �l JV �ture (Applicant or Agent): p��
Page 2
Application Number
.. . . .
04-00003639
Date 5/11/04
Special• Notes and
Comments
INSTALL:4 EA PARKING
LOT LAMPi.POST.W.ITH
6 LAMPS
Fee ,summary
Charged-.
Paid
Credited
Due
Permit Fee Total
87.00
.00
.00
.....
87.00
Plan Check Total
39.60
.00
.00
39.60
Grand Total
126.60
00
.00`
126.60:..:,:
i
'
TANDY'S
DATE
1
INSPECTION INC.
TIME I
Flin iV�:i f.•, iiZT i�j�ii "I E1•�.
PO BOX 13766
PHYSICAL ADDRESS
PALM DESERT, CA 92255
SPECIAL INSPECTION DAILY REPORT
OFFICE/FAX 909.769.9717
106 NAMEtc, Zk
PAGER 760.776.3339
ARCHITECT
ENGINEE
TYPE OF INSPECTION PERFORMED
Q�A,
SAMPLE INFORMATION
DATE
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PHYSICAL ADDRESS
PERMIT NUMBER
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LOCATION
106 NAMEtc, Zk
TYPE OF STRUCTURE
ARCHITECT
ENGINEE
WELDING INFORMATION
GENERAL CONTRACTOR
SUBCONTRACT R
_
WELDERS NAME'
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1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,
UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS
WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE
BUILDING LAWS.
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INSPECTORS CERTIFICATION AGENCY AND NUMBER
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1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,
UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS
WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE
BUILDING LAWS.
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1 HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,
UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS
WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE
BUILDING LAWS.
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INSPEECTT ^SSIIGNATURE
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INSPECTORS CERTIFICATION AGENCY AND NUMBER
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1YO U ♦ G '�1 ♦ -GI ♦ 1/ERI 'r `ti:i/ • SE-R+•I .X -CES -
<• Engineering,* Architecture -Surveying- Building & Safety Services
Lett er of Trans. -mitts]
To: City of La Quinta Date: 4/28/04 '
Project�_447--000 Washington_ t_•
Attn: Ed Randall PC#: PC 04-3639 (l'` Check)
Tel No.: (760) 777-7012 Tract No.:
We are forwarding: X By Messenger By Mail Your Pickup .
No. of Copies Description:
1 Electrical plans
1 Structural calcs w/ 11x17 details
Comments: Plans are approvable.
Thanks
This Material Sent for: ,
Your Files Per Your Request
Your Review x Approval
Checking At the request of:
Other
By: Eric Frenzel
Phone # 760-360-5770
77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) •360-5770
Bronz. Young