04-7378 (ELEC)BUILDING & SAFETY DEPARTMENT
504 (760).777-7012
.LE TAMPICO 3' ' FAX (760) 777-7011
CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
8- 1 _007378 Date 11/2.2/04
. 804467 VIA SAVONA ..
772-420-999-K -298943-
ption ELECTRICAL
LOW DENSITY RESIDENTIAL
Application valuation . 2500
r .
Owner Contractor
NRI CCP I LINTHICUM CONSTRUCTORS, INC.
811.00 AVENUE 53 17700 N. PACESETTER WAY
LA QUINTA CA 92253. SCOTTSDALE AZ 85255
(480),515-1700
WCC: EATON & ASSOC
WC:. MXI98383545 03/01/05
CSLB: 764528 03/31/06
CCC: A -B
Permit . . ELEC-MISCELLANEOUS
Additional desc
Permit Fee 33.50 Plan Check Fee .00
Issue Date Valuation 0
Qty Unit 'Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC.<=600V/<=200A 18.50
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Spec-ial Notes and Comments
ELECTRICAL PEDESTAL
Fee summary, Charged Paid Credited Due
Permit Fee Total 33.50 .00 .00 33.50
Plan Check Total .00 .00 .00 .00
Grand -Total 33.50 00 .00 33.50
P.O. Box 1504 &V4
.4
78-495 CALLS TAMPICO ��I�/� ,
w VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: ( 731 Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
MUILUING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (coencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice se, full force and effect. 1 a�J/ /rJ� G
License Class, ense No.
-iDatentractor /'' j28�/l/AJIf If
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 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 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Cohtractors''
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. , B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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
J4of the work for which this permit is issued.
4 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
M • rs compensations c aanncecard �I'¢y/�y rare:
Carrier _ y �I % Poles icy Number _ ! f- (!
_ 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 workers'
compensation laws of Califomia, and gree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provision
WARNING: FAILURE TO SECURE WORKERS' C6MPENSATION 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.
LENDING
ENCY
I hereby affirm under penalty of perjury that there is a construction lending agency orVthe performance of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name //��
Lender's Address A—
IMPORTANT Application is hereby made to the Director of Buildingand Safety N ACKNOWLEDGEMENT
for
y 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, andherebyauthorize representatives of this county to ente upon the above-mentioned property for inspection purposes.
Date �I r"/� R Signature (Applicant or Agent):