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05-0250 (ELEC)T4hf 4 4 Qgkl BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION ,REQUESTS (760) 777-7153 Application Number Property Address . . APN: Application description Property Zoning . . . . Application valuation . BUILDING PERMIT C5,05-00000250_ Date,1/25/05 . . . %_8.0790 -VIA P_ESSARO 772-500-002- - - . . ELECTRICAL . . LOW DENSITY RESIDENTIAL 600 Owner ------------------------ ND LA QUINTA PARTNERS,LLC 80110 AVENUE 53 LA QUINTA CA 92253 Contractor ----------------------- NATIONAL CONSTR RENTALS, INC. 15319 CHATSWORTH STREET MISSION HILLS CA 91345 WCC: DOUGHTERY CO WC: TRJUB4197201 05/01/05 CSLB: 687160 04/30/06 CCC: C10 -C13 -D31 7 ------------------------------------------------------------------------ Permit ELEC-.MISCELLANEOUS Additional desc Permit Fee . . . 52.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/25/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 -3.00 7.5000 EA ELEC TEMP SUB POLE 22.50 -------------------------7-7-------=---------------------------------------- Special Notes and Comments 1 TEMP POWER POLE & 3 SUB -POLES Fee summary Charged Paid Credited Due ----------------- --- - ------ ---------- ---------- ---------- Permit Fee Total 52.50 .00 .00 52.50 Plan Check Total .00 .00 .00 .00 Grand Total 52.50 .00 .00 52.50 V� p 2 5 2005 F toi INTA MCF e, P.O. Box 1504 " 78-495 CALLE TAMPICO so LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application NUMber: V' -4W.7 U Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: MUILUINU PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Cede, and Licens null ce and effect. incense Class tens (� J �te _ V rector goo,— OWNER43UILDER DECLARATION I hereby arm 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 ciaffirm ty 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 I hereby affirm under penalty of perjury one of the following decWORKERS' COMPENSATION DECLARATION larations: 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. 14i 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 My ers' compensation ins ce carrier a i ber r o icy Number �'�as���'�cj�� p _ I ertify that, in the perfoanc rme of the work for which this permit is issued, I shall not emplo 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 w rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio ---Date /_D v enn�ir.►� anf WARNING: FAILURE TO SECURE WORI�ER� PE SATION 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 performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address N APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety for A 1. Each person upon whose behalf this application is made, each person atwh whose request and to efor whose benefit workconditions and 'srestrictions 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 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 inform s co . I agree to comply with all city and county ordi s and state laws relating to building construction, and hereby authorize representatives of this county t ter upon the bove-mention rop inspection pu Date (Applicant or Agent):