06-2140 (ELEC)4 P.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/24/06
Application Number: 06-00002140 Owner:
Property Address: 81853 VIA LA SERENA TAYLOR WOODROW HOMES, INC
APN: 767-200-011-G -318742- 15 CUSHING
Application description: ELECTRICAL IRVINE, CA 92618
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1000
p Q p
Contractor:
Applicant: Architect or Engineer: BRAY CORP, SR DBA POWER
1005 N. EDWARD CT MAY 2 2006
I ANAH-IM, CA 92806
t (714)764-0020 CITY OF LAgUINTA
Lic. No.: 523696 FINANCE DEPT.
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 Code, and my License is in full force and effect.
License Class: C61 C10 D3 License No.: 523596
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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):
(_) 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 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.).
(�) I, as owner of th0 property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, BujAness 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ I I am exempt under Sec. B.&P.C. for this reason
Date: Y ' K wner.
CONSTRUCTION LENDING AGENCY
1 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: VV I LA
LQPERMIT
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury 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 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' compensation
insurance carrier and policy number are:
Carrier 8N HOME Policy Number WC717-16-34(CA)
Y -I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the rkers' compensati laws of California,
and agree that, if I should become subject to the w s' compen io visions of Section
3700 the La r Co shall forthwith comp) i those pr sio
�te:: plicant:RNG: F LURE 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 PROVIDED FOR IN
SECTION 3706 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, 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 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 informatio"rize
th all
city and county ordinances and state laws relating to building construction, es
of this c nt to en r upon above-mentioned propert pection pu
te: r gnature (Applicant or Agent):
Application Number . . . . . 06-00002140
Permit . . . ELEC-TEMPORARY POWER
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date Valuation . . . 0
Expiration Date 11/20/06
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 ON RETENTION BASIN LOT
"GIT
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
LQPERMIT
Charged Paid
30.00 .00
.00 .00
30.00 .00
Credited Due
.00 30.00
.00 .00
.00 30.00
05/23/2006 11:56 8589435151 TWH
PAGE 02
Bin #
PermitP.O.
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O`'A 14
1
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City Of La Quinta
Building a Safety Dh*lon
Box 1504, 78-495 Calle Tampico
La Qlenra, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project ,Address: — 7 (p (� Pf �Q z� v+%)
Owncr's Name: T O r
A. P. Number: -7(o-7-900—
Address: 1(045'-W', &-k ✓lQ {rs p (��. . ��Q
Legal Description: �'��
Contractor: �p G�~Telepborle:
Address: pp S' /�i . Eduj 2�
(?,IL,
City, ST, ZiP cJQ -L�-�I , (—A
S5- 9c�3 -S'/o o ''
Project Description:
City, ST, Zip: ei yyl C4
+ Q V ►�
Telephone:
City Lic.#;
JCQ AfWO i CL
State Lic. # :
�seln
es i �Q,. 1 n3'a�Y
Arch., Engr., Designer.
G V i 0. A .-
Address:
" S-Q-� r n
City, ST, Zip:
Telephone:
State Lic.
Name of Contact Person;
—rl V'lyi 7()
Construction Type: Occupancy:
kK Project type (circle one): New Add'n Fuer Repair Demo
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: �% �r�%
pp
p
Estimated Value of Project t
APPLICANT: DO NOT WRITE BELOW YNIS LINE
N
Submittal
Reg1d
Recd
TRACMG
PT! RMT UES
Plan Seta
Plat Cheek submitted
Item
Amount
Structural Calm
Reviewed, ready for corrections
Plan Check ]Depesit
Truss Cates.
Called Contact Person
Plan Cheek Balance
Titte 24 Calcs.
Plans pied up
Construction
Flood plain plan
Plans resabmlued
Mechanical
Grading plan
Yd Review, ready for eorreetlonslissue
Electrical
Subcontactor List
Caned Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.W. Approval
Plana resubmitted
Grading
IN HOUSE:-
Review, ready for eorreetions/tttae
Dcvdoper impact Fee
Piannlag Approval
Called Cootaet Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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