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07-1655 (ELEC)4 . P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT' INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/06/07 Application Number: 07-00001655 Owner: Property Address: 79710 HIGHWAY 111 HIGHLAND LA QUINTA, LLC APN: 649-020-014-3 -31143 - 1055 E. COLORADO BLVD. #5178 Application description: ELECTRICAL PASDENA, CA 91106 Property Zoning: REGIONAL COMMERCIAL Application valuation: 1500 D a ntractor: Applicant: Architect or Engineer: r VEST �� c f�2208 WASHINGTON STREET PMB153 /^ JUNV ZOO, (BERMUDA DUNES, CA.92201--0 ( �y ClryOF� (760) 360-7061 ►1111��� Lic. No.: 876299 ------------------ 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 ess and Professionals Code, and my License is in full force and effect. License Class: B Llcen o.: 8762996ate: � ontractor: t , 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).: 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.). 1 _ 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 contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _) I am exempt under Sec. , BAP.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: LQPER1111T 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 STATE FUND Policy Number 1846155 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 sub to the workers' compensation provisions of Section 700 of the Lab de, I with c y wit a provisions. Date: App scant: WARNIN : 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 1$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 gree to comply with all city and county ordinances and state laws relating to buildsP9 construction, and hereby a h ize representatives of this un to nt upon the above -m roperty ?orion p as. rDa[ iggnature (Applicant or Agent)' L _ _ �c Fa Application Number . . . . . 07-00001655 Permit . . . . . ELEC-TEMPORARY POWER Additional desc . Permit -Fee. . . . .. 60.00 Plan Check Fee .00 Issue Date . . . Valuation .. . . . 0 Expiration Date'. 12/03/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 4.00 7.5000 EA ELEC TEMP SUB POLE 30.00 Fee summary Charged- --------------------------- ---------- Paid Credited -------------------- Due Permit Fee Total 60.00 .00 .00 60.00 Plan Check Total .00. .00 .00 .00 Grand Total 60.00 .00 .00 60.00 LQPERM[T 06/05/2007 TUE 13:49 FAX R001/001 Bin #Ci to Quinta':, .. " City of . Building :8t Safety Division - Permit 9 - ' P.O.- Box 1 SO4, 78-495 Calle Tampioo La Quinta, CA 92253 - (760) 777-7012 -Building Permit Application and Tracidng Sheet Project Add rw-• ,y ciwkea'sName• A P. Number Address:(cO Description City. S "r, Contractor./2(/ Telephone: " ILegal Addtess:• �s®� /Ii5l�l�J a S' / — •PmjeetTk§aiption City, sr, Zip:. . • / o StaftLk#*-` , Address: city, ST:-rlp• ` Telephone:,Cons�aroa Type: / L Oocapancy: Lia #: Project type (cicole one): Addl'nAlter Repair Demo Name of Contact Person: -Sq; FL:#25w 5� #Units i �+ Telephone # of Contact Pei3on 5' Estimated Value of Projecfi APPLICANT: DO NOT VYR17 E BELOW 1 lI1S "UNE Y." Sab�pitlal" .. Req'd • Ree'd TRACI@lCf: " PEjtMfl'FEFS Plan Sob Plan Check mbmhted [tem Amount StrRetnral Cala.. " Revkvud, ready Or eormHons Plan C3teck Deposit Tress Cala. Called CotnaftPerson PIaa.Check Balance" Energy Cala. Plans pcked dP Construction ' Flood pliin pin, . Plans.ie dInUted .. Mechaakal " • Gradlnplan. 2`! Review, ready for eorreetions/issue " ' Electrical, Sabeontietor" List Canep.Contaet Peron " Plumbing - 'Great Deed Plans picked up S.M.L H.O.A Approval. Plans resubmitted Tg W HODS % ''' Review, ready for eorrectlodealut Developer Liipact 1<ee P1a°°l98 Approval Called Contact reraoa A.LP�. Pub. Wks. APer Date of permit issae Sehool Fen tl Total Permit fees.