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04-6481 (ELEC)Titf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . .04-00006481 — Date Property Address . . . . . . 81350 LEGENDS WY APN: 762=420-007- - - Application description ELECTRICAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 100 Owner --------------------- TOLL 81240 LEGENDS WAY LA QUINTA CA 92253 9/28/04 Contractor ------------------------ TOLL BROS, INC. 73121 FRED WARING DRIVE, #100 PALM DESERT CA 92260 WCC: LIBERTY MUTUAL WC: WA762DO04723014 09/01/05 CSLB: 77769.9 04/30/06 CCC: B ---------------------------------------------------------------------------- Permit . . . . ELEC-MISCELLANEOUS Additional desc Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ----------------------------.---.-- ----------------------------------------- Special Notes and Comments TEMP POWER POLE Fee summary Charged Paid Credited 'Due ----------------- ----------- ---------- ---------- ---=------ Permit Fee Total 30.00 .'00 .00 30.00 Plan Check Total .00 .00 .00. .00 Grand Total 30.00 .00 .00. 30.00 SEP 2 9) 2OM] i� �oyy CF P.O. Box 1504 78-495 CALLE TAMPICO f�V V VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04(- j�o 4 g" I Date: Applicant: I Architect or Engineer: (— 'Oy Appucanus mailing Address: Arcnitect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS A 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 e,and my Licegp� is in full force and effect. License Class 17 _ icense No. -1-7-109 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 1, 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 1, 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.). ( j I am exempt under Sec. , BA P.C. for this reason Date Owner. I hereby arm under penalty of perjury one of the following declarraattiionsRS' COMPENSATION DECLARATION affirm 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. 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 issued. My workers' compe�th sce carrier and policy number are: artier l.Ic��cLT,! My?uAl�cy Number4I certify tfiat, in the performancork for which this permit is issued, I shall not employ 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 workers' compensation provisions of Section 3700 of the labor Code. I shall forthwith comply with those provisions. 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 PROVI SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. DED FOR IN I herebyaffirm under CONSTRUCTION LENDING AGENCY 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 Buildingand SafetyA orth on this 1. Each person upon whose behalf this application is made, each person at Permit le request a d forto the whosewhose benefit work snditions and nperfo s set frmed under or pulrsuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City o1 La Ouinta, 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Signature (Applicant or Agent). � r