10-0665 (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: 10/07/10
Application Number: 10-000006651- Owner:
Property Address: 47225 WASHINGTON ST ROMAN CATHOLIC BISHOP O /[J► Q
APN: 643-090-026-2 -000000- 1201 E'HIGHLAND AVE
Application description: ELECTRICAL SAN BERNARDINO, CA 9240
Property Zoning: LOW DENSITY RESIDENTIAL JJ OCT n ry
Application valuation: 273272 • 0J
CITY(IF
Contractor. 1'",ya;.', or�(J"YZA
Applicant: Architect or Engineer: ORR BUILDERS E::+�}
39301 BADGER, SUITE #300
PALM DESERT, CA 92211
(760)360-6632
( Lic. No.: 693077
LICENSED CONTRACTOR'S DURATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licen under ;" isirons 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 Pr essi Lode, and y 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 Class: B icense . 693077 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r7 issued.
tractor: �1 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 DELOS INS _ Policy Number, 03DKRM12003959
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county. that requires a permit to _ I certify that, in the performance of the work for which 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 manner so as to bgbi
act to 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 should becomo rkers' compensation provisions of Section.
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sh o y with 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 ($500).: icant:
1 I 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself.or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions'Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person -at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. B.&P.C. for this reason 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 .
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:
LQPERMIT
performed under or following issuance of this permit.
2. Any permit issued as 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 above ' orrn n ' orrect. I agree to comply with all
city. and county ordinances and state laws relating to building c sir , and hereby authurixe representatives
of county to enter up o the above-mentioned property f / n purposes.
ate,/Ifi /i, nature (Applicant or Agent):
Application Number . . . . . 10=00000665
Permit . . .. ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . 78.50 Plan'Check
Fee
19.63
Issue Date Valuation.
. . .
0
Expiration Date 4/05/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
60..00. .7500 EA ELEC-POLE LIGHT
45.00
1.00, 18.5000 EA ELEC SVC <=600V/<=200A
18.50
Special Notes and Comments
60 LIGHT POLES WITH FOUNDATION AT
PARKING LOTS PER ENGINEERED PLANS..1 NEW
100 AMP PEDESTAL.,20.07 CODES / 2008-
' ENERGY.
Fee summary - Charged • Paid- Credited
Due
Permit Fee Total 78.50 .00
.00
78.50
Plan Check Total 19.63. .00
.00
19.63
Grand Total*- 98.13 .00
.00
98.13