05-0667 (ELEC)S
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BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
1-499 CALL AMPICO FAX (760) 777-7011
LA QUINT 4FORNIA 92-2.5.3 INSPECTION REQUESTS (760) 777-7153
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FEB 2 - ZOU5 "� BUILDING PERMIT
c1 -TY -0. f LA QUIN A
Application NURrer"- . '. .
Property Address . . . .
APN:
Application description .
Property Zoning . . . . .
Application valuation . .
. 0.5:-00000667
48`921 EISENHOWER DR
658 -170 -005 -
ELECTRICAL
. TOURIST COMMERCIAL
10+0
Date 2/24/05
Owner Contractor
CENTEX CENTEX HOMES
41685 BOARDWALK 901 N. GREEN VALLEY PKWY, 140
PALM DESERT CA 92260 HENDERSON NV 89074
(702) 990-080.0
WCC,: ZURICH AMER INS
WC: WC83220:9708 10/01/05
CSLB: 825943 1:0/31/05
CCC: A -B
Permit . . . ELEC-SERVICE CHANGE
Additional desc . .
Permit Fee 52.50 Plan Check Fee .00
Issue Date . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 37.5000 EA ELEC SVC <=60,OV/>20OA/<=.1000A 37.50
Special Notes and Comments
400 AMP SERVICE FOR SALES TRAILER
Fee summary Charged
Permit Fee Total 52.50
Plan Check Total .00
Grand Total 52.50
Paid Credited Due
.00 _.00 52.50
. 0,0. .00 '00
. GO . GO. 52.5 0
P.O. Box 1504 • VOICE (760) 777•7012
79-495 CALLE TAMPtCO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: tJj D Dater
Applicant: Architect or Engineer:
Applicant's Mailing Address: + Architect or Engineer's Address:
Lic. No.:
BUILDING 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, Divislon 3 of the Business and Professionals
Code, and my Licen a is i ll force and;effect. ntr�,,•-�► �J '?
License Class License No. jf
Date � Z d� Contractor
OWNER -BUILDER DECLARATION
I hereby;afflrn under penalty of perjury that l am exempt from the Contractors' Stets License Law for the follovvfng reason (Sec: 7031:5„Business', end!Professlons Code: Any
city, or county that requires a permit to constructs 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 byany 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, ormy employees with wages as their sole compensation, will do the work, and the structure Isnot' intended or offered for sale (Sec. 7044„
Business and Professions Code: The Contractors' State License Lew;does not apply to an owner of, property who buildsior 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 orimpmvementis
sold within.one year of completion, the owner -builder will have the burden of proving that he orshe did not build or improve -for the purpose of sale.).
U I; as owner of the property, am exclusively contracting with licensed contractorsto 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 RC. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of,pedury 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
Of the work forwhich this permit is issued.
I have and will maintain workers' compensation insurance, as. required bySection.3700 of the Labor Code, for the performance of the work for which this permit is
issuedo ars' mpensation insurance carrier and poli umber are;
Carver 7� � i911S Policy Number 9 7 -A [�
_ I certify that,n the performance of the work':for which this permit iv sued, I shall not employ,any person in any manner so as to become subject the workers'
compensationdaws of California, aow*84% that, if I sh uld become subject to the workers' compensation provisions of Section 3700 -of the Labor Code, I shalt
forthwith comply with those proyi ns: Y
Date Z 2 �� F,pplicant
WARNING: FAILURE TO SECURE W RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED T USAND DOLLARS ($10000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODENNTEREST. 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.).
Lender's Name.
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made -to the Director of Building and Safety for a permit subjecfto the conditions and restrictions setforth 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 Le Quinta, its
officers, agents and employees for any actor omission related to the, work:being performed underorfollowing issuance,of this; permit.
2. Any. permit issued as a result:of this application becomes null and vold'if work isnot 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'information is- rreet. I agree to compl with all city and county ordinances and state laws,relabng to building
construction, an hereby authorize. representatives of this cou a ter up,,,a -mentio Ry for inspection purposes.
Date 6t r
Signa u e (Applicant or Age t):