06-0507 (ELEC)P:O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'.
Application Number:
06-00000507
Property, Address:
56985LLAGE DR
APN:
764-060-004- - -
Application description:
ELECTRICAL.
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
200
Applicant: -
Architect or, Engineer:
i
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
FEEB 012006
ITY OF LiI► QUINT'A
Owner:
THE PALMS HOA
C/O AVAIL PROPERTY MGT
P O BOX 1032
PALM DESERT, CA 92261
Contractor:
RANGEL, INC.
77670 SPRINGFIELD LANE, STE #9
PALM DESERT, CA 92211
,t
VOICE (760) 777-7012
FAX (760) 777.-7011
INSPECTIONS (760) 777=7153
Date: 2/01/06
`
•(760)200-5220
Lic. No.: 753548
" LICENSED CONTRACTOR'S. DECLARATION • -
-----------------------------
- `WORKER'S COMPENSATION DECLARATION'
I hereby affirm under penalty of perjury tha6 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 will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C10- License No.: 753548 -
_
for by.Section 3700 of the Labor Code, for the performance of the work for which this permit is
'
issued.
Date: f ? Contractor:.
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
' - OWNER -BUILDER DECLARATION -
insurance carrier and policy number are: -
- I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier CLARENDON INS Policy Number 01KR0030869
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
- construct, alter,1mprove, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
— person in any manner so as to became 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 forthwith comply with those. provisions..
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 ($500k:Date:
_
' ' • Applicant: _ _ -
1 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the worknd
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
—
WARNING: FAILURE T SECURE`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 _1
1
- DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
,. improvements are not intended or offered for sale. If, however, the building or improvement is soldxaithin-
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—) 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 application.
property who builds or improves thereon, and who contracts for the projects with 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 lam 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
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:
LQPERMIT - -
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject - - - - -
permittto cancellation. - - -
I certify that 1 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, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purpose
s.
/
Dates e: Signatures (Applicant or Agent)'
I Bih-#
` Permit # v
Project Address:s� a5 -UI a
A: P. Number:
Legal Description:
Contractor: C
Address:
City, ST, Zip:
. Telephone: () 602,06 -Y tz .6
State. Lid. # : [ / a .-. S 3 8'
Arch., Engr., Designer: "
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone #9f Contact Person:
# I Submittal
Plan Sets
Structural Cafes.
Truss Calcs.
Energy Cafes.
Flood plain plan
Grading. plan-
Subcontactor List
Grant Deed
H.O.A. Approval
IN ROUSE:-
Planning
OUSE: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 922.53 -.(760) 777-.7012
Building Permit Application and Tracking Sheet
Owners 1;,
Address:. O
City, ST, C
Project Description:
MOWN
Total Permit Fees
Construction Type:
Occupancy:
P cy:
Project type (circle one): New Add>n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project:2
rq n
APPLICANT: DO NOT WRITE BELOW
THIS UNE
Recd
TRACKING -
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans. picked. up
Construction
Plans resubmitted
Mechanical
2-" Review, ready for correctionsrssue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
3" Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.LP.P.
Date of permit issue
Total Permit Fees
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