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05-3655 (ELEC)P.O. BOX 1504 VOICE 760 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETYDEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT. Date: 8/22/05 Application Number: Q5-0.0.0-.3.655 Owner: Property Address: S3012 -VIA DONA Lry VISTA LA QUINTA PARTNERS APN: 772-420-999-I -298943 223 E. DE LA GUERRA Application description: ELECTRICAL AUG SANTA BARBARA, CA 93140 Property Zoning: LOW DENSITY RESIDENTIAL 2 2005 Application valuation: 1200 ' CITY OF LA QUINTA ` FINANCE ®SPT. Contractor:.. Applicant: Architect or .E eer.-- " '~ COCHRAN COMMUNCATION CONST ,INC 36630 CATHEDRAL CYN DR CATHEDRAL CITY, CA 92234 - Lic. No.: 478543 LICENSED CONTRACTOR'S DECLARATION_ r WORKER'S COMPENSATION DECLARATION - hereby affirm under penalty of perjury that I am licensed under provisions of 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 Professionals Code, and my License is in full force and effect. _ I have and wi11'maintain a certificate of consent to self -insure for workers' compensation, as provided - License Class: C7 License No . 478543 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - ati_ � issued. - - - , �Z' ontractor: 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: , hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Carrier STATE FUND Policy Number 04600082625 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ 1 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 become subject to the 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 become subject to the workers' 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 shall fo hwithhwlth comply those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ® J— any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.:ate: (_) 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 ASPROVIDED 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 I; 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 applicatiom 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 performed under or following issuance of this permit. - - Date: Owner: 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 CONSTRUCTION LENDING AGENCY permit to'cancellation. hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that -the above information is correct. I agree to comply with all - work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co my to enter upon the above-mentioned pro yr inspect n purposes. Lender's Name: - xR��Zv, upo te: !/ Si ure (Applicant or Agentl: Lender's Address: �X - LQPERMIT ;_.. Application Number . . . . . 05-00003655 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee 33.•50 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 2/18/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 18.5000 EA ELEC SVG <=600V/<=200A 18.50 --------------------------------------------------------------------------- Special Notes and Comments 100 AMP METER PEDESTAL " Fee summary Charged Paid Credited Due Permit Fee Total 33.50 .00 .00 33.50 Plat Check Total .00 .00 .00 .00 Grand Total 33.50 .00 .00 33.50 Truss C r77Title 24 :: is Plasoii �w•.i %� r-- jr r t y�,-x � ,$`},.ab Ck�i � �j t �,..� ^�� � i lr r