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05-5122 (ELEC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht 4 4 �� Gt/ BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . Application Number: 05-00.0051-22-L-Z Owner: Property Address: 77750 AVENUE 50 LA QUINTA COUNTRY CLUB APN: 658-190-003- - - P O BOX 99 Application description: ELECTRICAL D A LA QUINTA, CA 92253 Property Zoning: GOLF COURSE Application valuation: 1000 i\ , f1S� 1NO Y 3 2005 Contractor: it Applicant: Architect or Engineer: WALL CONSTRUCTION, INC., DOUG CITY OFL,AQUINTA 78450 AVENUE 41, FINANCEDEPT. INDIO, CA 92201 (760)772-8446 Lic. No.: 743112 r.� ------------------------------------------------- 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 Professionals Code, and my License is in full force and effect. License Class: A B C9 C27 License No.: 743112 !aat��U 7i"/VS/Con�teictor:.�(� _. 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 I, as owner of the propeny,.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.). (_ 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: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 —-————————————— — — - WORKER'S COMPENSATION DECLARATION ' Date:11/22/05 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 0460004815 I certify that, in the performance of the work for which this permit is issued, 1 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 Code, I shall forthwith comply with those provisions. Date:=� : OS A licant: 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 Ouinta, 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 city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co my t ent upon the above -mentioned property for inys/pyDect�ion purpo Da nature (Applicant or Agent): LQPERMIT Application Number . . 05-00005122 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . . . 15.75 Plan Check -Fee 3.94 Issue Date Valuation 0 Expiration Date 5/21/06 Qty Unit Charge. Per Extension BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/•FIXTURE 1ST 20 .75 ---------------------------------------------------------------------------- Special Notes and Comments TEMP ELECTRICAL FOR PORTABLE RESTROOMS Fee summary Charged Paid Credited. Due Permit Fee Total 15.75 .00 .00 15.75 Plan Check Total 3.94 .00 .00 3.94 Grand Total 19.69 00 .00 19.69 LQPERMIT NovA_8 05 04:35p Integrated Infrastructure 909 46D 1890 p.2 Bin # City of La Quinta Building 8z Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # // ZZ -� Project Address: ((. 7�Z 4.X• , 50 Owner's Name: A. P. Number: Address: Legal Description: Contractor: G, `( Gp��}-� n G Address: -7 1 City, ST, Zip: 1 U Telephone: Project Description: City, ST, Zip; (A011A4, Qwills C —I 2;�k Telephone: , State Lic. # : -74 3 l 2 City Lic. #: 3' (0 Arch., Engr., Designer: Address: !7'6f City, ST, Zip: V Telephone: iJf )G , t �� •�:?. "� State Lic. #: , - /�',,� Name of Contact Person: • j�,� e� ' Comgru.ction Type: Occupancy: Project type (circle one): ` e Add'n Alter Repair Demo Sq. Ft_: f �') # Stories: t f # Units: f Telephone # of Contact Person: Estimated Value of Project: APPUCANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd 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 Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan Zid 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 Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 'ov a 05 04:3PIo Integrated Infrastructure 909 460 ,1890 P•3 O lot - PROPOSED TEMPORARY RESTROOM BUILDING 12' x 40' EXISTING CLUBHOUSE \ Ei� Quinta 77-750 Avenue 50 la Quints, CA t:�.:;��:r �.r.:• DRAWN HEINZ 1L" ,•�' ~:iy T=UDf%CAClV ,�IrNiT Tf�•�.,