05-4967 (ELEC)4 P.O. BOX 1504 ^'
78=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:05-000r
04967 Owner -
'
a Property Address: %8087-1 VISTA LAZO TODD SHERMAN
APN: 762-250-010- - - 80871.VISTA LAZO
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2500
Applicant: Architect or Engineer:
-- - - - - - - - -- - }-- - - - - -- - - - - =-
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 rofessionals Code, and my License is in full force and effect. -
LicenseCla B. LicenseNo.: 8545969
Date: Contractor:
f 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 licensedpursuant 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 (5500).:. .
1 _ 1 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 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 1 I am exempt under Sec. B.&P.C. for this reason
1
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: -
LQPERMIT i" _
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/15/05
Contractor:
SKYE CONSTRUCTION, INC.
2240 ENCINITAS. BLVD, STE•D
ENCINITAS, CA 92024
(760)594-2282
Lic. No.: 8545969®V 42005
CSE QUINTA
-
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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. -
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 EXEMPT Policy Number ' EXEMPT
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 b ome subject to the workers' compensation provisions of Section - -
77000 of the Labor all forthwith comply with those provisions. -
Date:( l ww Applicant:r- .
WARN( G: AILURETO 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 fromdate 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 tMtheaboformation is correct..( agree to comply with all
city and c my rdmances and state laws relating truction, and hereby authorize representativeof thisco tyye%pr upon the above-mentioned ection purposes.
Signature (Applicant or Agent
Application Number . . . . . 05-00004967
Permit ELEC-TEMPORARY POWER
r-
Additional desc ..
Permit Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 0
Expiration Date 5/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 :15.0000 EA ELEC TEMPORARY POWER POLE
----------------------------------------------------------------------------
15.00
Permit . . ELEC-TEMPORARY POWER
Additional desc .
Permit Fee 37.50 Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date 5/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE_
.15.00
1.00 7.5000 EA ELEC TEMP SUB POLE
7.50
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Special Notes and Comments
---------------
200 AMP METER POLE ON RESIDENTIAL LOT
WITH SPAN POLES TO.EXISTING WELL SITE
_
Cr
WITH 1 SUB POLE. IRRIGATION FOR ROUGH
GRADING PROVIDED BY WELL SITE
Fee summary Charged Paid Credited
Due
s--
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-- ---
Permit Fee Total 67.50 .00 00
67.50
Plan Check Total 00. .00 00
.00.
Grand'Total 67.50- .00 :00
67.50
LQPERMIT
Bin #
City of La Quinta
Building & 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: 607
V i S T l L12-0
Owner's Name: 77S e y� LL(—
L(—
A. P.
A.P. Number:
Address:
9,3l0 e4 moo, kv & e
v N `�
Legal Description:
City, ST, Zip: ! ®
Contractor: KYLt.(�/IS
6� 710 TJY
p ,��— — �. W, P
Telephone:
Project Description: ejpil CC9e- 2.
b
0 L4E-
Address: ;ZZYp f-Noj,(t4wu 31. v,-4) S7'6 Z Ll
City, ST, Zip: EIYU"!
C4Z
p
Telephone: )bp—SQy.0
•� ;
State Lic. # : S6
City Lic. #:
Arch., Engr., Designer:
.�c G
Address:
City, ST, Zip: `
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project;L•SOO =�-.:-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Baiance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up,
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer.Im pact Fee
Planning Approval
Called Contact Person.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees