05-2112 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-000.02112
Property Address:
APN: 7840.5 HERITAGE
Application description: 643-170-9.99-5
Property Zoning: ELECTRICAL
Application valuation: LOW DENSIT
Applicant:
T4tyl 4 4 Q- ",
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
WY PH RANCH LLC
-31348 - 783,70 HIGHWAY 111 STE :200
LA'QUINTA, CA 92253
Contractor:
Architect or Engineer: a ------------------ -----------------
ESER-T- POWER .
999 ;S NAVAJO' DR-IVE'.
/� SPRINGS; CA 92264
A L'c. No.: EXEMPT
Date: 5/31/05
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION' DECLARATION.
I hereby affirm under penaltyof parjury.'that I am.licensed under provisions of Chapter..9 (commencing with I hereby,affirm under penalty of perjury one of ths4ollowing declarations:
Section 7000) of Division 3 of the,Business and Professionals Code; and my License is'in full force and affect. _ I have and will maintain,a certificate of consent to self -insure for workers' compensation, ed, provided
License ctass:c 824337 License No:: :EXEMPT for by Section 3700 of the'Lsbor Code„for the performance of the work.for which this permit is
- issued.
Date:, - ontracta . I have and will maintain workers' compensation insurance, as,required.by Section 3700ofthe Labor
Code, for the:performance of the work for which this permit is;issued. Myworkers' compensation
O ER$UILOER DECLARATION insurance carries_ nd,policy'numbarare:
I hereby affirm.under penalty of perjury --that I ant,exempt from the Comractor.'s State License Law for the Carrier 8851 Policy Number EXEMPT
following: reason (Sec. 7031..5, Business and Professions Code: Any cityorcounty that requires a permit to I certify that, in the performance of the•work•for'which this
permitis'issued, -1 shall not employ.any
construot;,aker, improve: demolish; or repair any structure, prior;to ifs issuance; also, requires thwappligent for the person. in any mennerso as to became subject to Yhe:workers' compensation laws of California,
permit to _file a' signed 'statement that he orshe;is licensed pursuant,to the provisions,of the•Contractor's State and agree that;.if I shoul&bacome subjectto the workers',compensation provisions'of Section
License Law (Chapter 9 (commencing with'. Section 1000) of'D(vision73: of, the Business and Professions Code) or 3700 offhe Labor Cada I - sd^ll f-rthwiftWomolv,w11h-*tiossprovisions.
that he,or she is exempt therefrom and the basis for the,allapedexemption. Any violation of Section 7031,:5` by
any applicant fora permit subjects the applicant to a civil penalty of not_more,then five hundred.dollars (9500);:
(_) 1, as owner of the property; or my employees with:wages;as theirsole compensation, will do the work; and
the structure,is not intended or offered forsale I'Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not4pply to amowner of property who builds or improves thereon,
and 'who does the work himseff'or:herself, through his or her own employess; 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 ofproving that fis or she did not build or
Improve for the purpose of sale.).
1 _ 1 I, as owner of the am exclusively coMrecting,wRh licensed contractors:tboonstnictthe project (Sec:
7044,, Business and Professions Code:, The Contractors' State License Lew does not;appiy to;an owner of
propertywho'builds or'improves thereon, :and who contracts for the projects with a contractor(s) licensed.
pursuant to the Contractors' State License Law.).
(_ 1 Bain exempt under Sec. , B.&P.C. fonthis.reason - - - -
Date:
Owner:
CONSTRUCTION LENDINO'AGENCY
I hereby affirm under•penafty of perjurythat there is,a construction lending agency for the performance otthe
work,for'whichthis permit is issued'(SeC.r3097; Civ. C.).
Lender's Name:
Lender's Address:
LQPER11IIT
WARNING: FAILURE TO SECORE WORKERS' COMPEMSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND.CIVIL:FINES UP TO ONE.HUNDRED THOUSAND
DOLLARS (9100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
SECTION 3708.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 behalf this application is made, eech.person at whose request and for
whose benefit work1s performed underrorpursuant to;any permit issued as result of this application,
the owner; arid the_applicant; each agrees to, and shall defend, indemnify and hold harmleasthe City
of La Quints; its officers, agents and employees for anyact or omission related to the work ,bsing
performed under or following issuance of this permit.
2. Any permit issued as a,result'of'this applicationbecomes. null and void if work,iWnot commenced.
within 180 dep'from date of'issuanoe'of'such permit, or oessation of work -for l.80 days will subject
permit to cancellation.
I certify that, 1, have, read this application and state that the above,information is correct. Ifagree to complywith all
city and 'county ordinances: andstate,laws-relating -
. ngtobuilding construction, an--reby'authorize'rep resenta[ivesr
of thiscount t�n the above-mentioned' Property for ion es.
pate: ture (Applicant or Agentl: - - -- -
410,
1 •
[4M
LQPEabUr
Application Number . . . 05--000.0211-2
Permit. . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 165.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date 11/27/05
Qty Unit Charge Per Extension
BASE FEE 15-.00
1.00 15.0000 EA ELEC TEMPORARY POWER.P.OLE .15.00
18..0'0 7.5000 EA ELEC TEMP SUB POLE 135..00
Special Notes and Comments
TEMP POWER POLE & 18. SUB POLES
Fee summary Charged Paid Credited Due
----------------- --- -------------------------- -------
Permit-Fee Total 1.65.00 .00 .00 165.00
Plan Check Total .00 .00 .00 .00
Grand Total 165.00 ..00 .0'0 165.00