07-1446 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00001446
Property Address: 80140 VIA TESORO
APN: 772-250-018-6 -31349
Application description: ELECTRICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
Applicant:
Tiht 4 4 Q"
Architect or Engineer:
P `A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 lid Professionals Code, and my License is in full force and effect.
Lic nseClass: Bcens No.: 777699
•
Dat 2 Z ontractor.
OWNER-BUILDIR 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 _) 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.).
(_ 1 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 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
14350 N 87TH ST #310
SCOTTSDALE, AZ 85260
(480)951-0782
Contractor: D
TOLL BROS, INC.
14350 NORTH 87TH ST,
SCOTTSDALE, AZ 85260
(760)674-9699
Lic. Nct.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/22/07
#3MAY 2 2 2007
CITY OF LA QUINTA
FINANCE DEPT.
WORKER'S 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 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 AMERICAN Policy Number WC387821301
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,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor_C2de,fshall forthwith co ply th those provisions.
-L2
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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
city and c my ordinances and state laws relating to building construction, and hereby autho ize representatives
of thi ounty to enter upon a above-mentioned property for nspection purposes.
Kate, Z'�• nature (Applicant or Agent):
Application Number . . . . . 07-00001446
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
33.50
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . .
11/11/07
Qty Unit Charge
Per
Extension
DAOL
PEE
15.UU
1.00 18.5000
EA ELEC
SVC <=600V/<=200A.
18.50
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
LQPERAIIT
Bin #
(Permit #
Project Address:' IKO
A. P. Number:
Contractor: �-
Address: j 3�
City, ST, Zip: SC O -.s /:
Telephonc:'( _ 167
State Lic. # : 7 e
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Cales.
Truss Calcs.
Energy Cales.
Flood plain plan
Grading.plitn•
Subcodtactor Ust
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta -
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-012
Building Permit Application and Tracking Sheet
7 Q,' a j Q Owner's Name:
O " O 1 fS 7 r.tefi# 3/3 9 Address: / C� 3 CO /U g' >� 9-1-
c
,O City, ST, Zip: S G 64IL3 Z>Adv,
t K 43" Telephone: 0 6_ Z
Project Description:
4.4
Ot, fa d a t'a. t s -
M
Lic. #:
— ) a, I -es arc
?.2 -oiSG- DIS —(o - 3134
Construction Type: & , J.C,.,4� panty=
Project type (circle one): w Add'n Alter Repair Demo
Sq. Ft: . # Stories: # Units:
Estimated value of Project: 3'
APPLICANT: DO NOT WRITE BELOW THIS UNE
Recd
Plan Check submitt`�
Reviewed, ready for
Called Contact Peso
Plans Picked up
Plans resubmitted
2" Review, ready for
Called Contact Perso
Plans picked up
Pians resubmitted
Review, ready for.
Called Contact Perso
Date or permit Issue
TRACKING • PERMIT FEES
Item
Amount .
corrections Plan Dkeck Deposit
a Plan ;'heck Balance
Construction
Mechanlcal
correcdonsrusue Electrical
a Plumbing
S.M.1
Grading
corrections/issue Developer Impact Fee
A.LP.P.
Total ?ermit Feu