06-0605 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: �__Q6T0000060:5'
Property Address: 80515 VIA TALAVERA
APN: 772-250-999-145 -30357•-
Application description: ELECTRICAL
Property Zoning: LOW DENSITY -RESIDENTIAL
Application valuation: 1230
Applicant: Architect or Engin(
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
3 Ci ✓ 2006
CITY OF
LICENSED CONTRACTOR'S DECLARATION '
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: B License No.: 777699
ate r 7 ontractor:
Loe
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).:
(_ 11, 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 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.).
1 _ I I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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: A
LQPERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
Contractor:
TOLL BROS; INC.
14350 NORTH 87TH ST, STE #310
SCOTTSDALE, AZ 85260
(760)674-9699
Lic. No -:,777699
VOICE (760) 777-7012 .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/09/06
y
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyof 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 ZURICH INS Policy Number WC387821300
_ 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 California,
andagreethat, if I should become subject to the workers' compensation provisions of Section
�3700 of the Labor ode, I sha�frnhwithhcommply/wiitth those provisions.
..7_C, ^cant:
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 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 information is correct. I agree to comply with all
cityY�n
dinances and state ws relating to building construction, and hereby authorize representatives
of tter upon the ve-mentioned property for inspection, p ses.Da Si ture (Applicant or Agent): '
Application Number . . . . . 06-00,000605
Permit . . . ELEC-TEMPORARY POWER
Additional desc _
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue. Date Valuation
0
Expiration Date 8/08/06
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 TO SERVICE LOTS 144-&
145
Fee summary Charged Paid .Credited
Due
--------- ---------- ---------- ----------
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total- .00 .00 .00
.00
Grand Total 301.00 .00 .00
30.00
a
LQPERMIT
Bin #
City of La. Quinta
Building u Safety 'Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -.(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Moo hj t QL a C
Owner's Name: •10 3 r o Y--5
A. P. Nurhber:,
Address: S-0 "5/100 3-C f6g r -So
Legal Description:
City, ST, Zip: L 14 Oj fC,
Contractor:
Telephone: 761 ;?o,-S:Vs
Address:-
Project Description:
City, ST, Zip:
+ -b I
Telephone:
State Lie. # City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: g
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:'
Project type- (circle .one) :* 'New Add'n Alter Repair Demo
Sq. Ft.:
# StoriesUnits:
Telephone # of d-o'ntact, Person:
Estimated Value of Project: ;t
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec,'d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List.
Called Contact Pe I rson
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
W HOUSE:-
Review, ready for corrections/issue'
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees