05-5414 (ELEC)-a
,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
BUI G PERMIT
Date: 12/12/05
Application Number: 05-00005414, Owner:
Property Address: 77750 AVENUE 50 O LA UINTA COUNTRY CLUB
P Y Q
APN: 658-190-003- - - ` P O BOX.99
Application description: ELECTRICAL �OQ LA QUINTA, CA 92253
Property Zoning: GOLF COURSE nj 1r P
Application valuation: 50000
Contractor:
Applicant: Architect or Enginee G` WALL CONSTRUCTION, INC., DOUG
78450 AVENUE 41
r4 INDIO,.CA 92201
I (760) 7724
Lic. No.:: 743112
---------------------------------------------------------------------------------------------------
LICENSEDCONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that I 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: A B C9 C27 License No.: 743112 .for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
¢CIA Mgt issued.
/[late: /` �/V ontractor: _ 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
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
r^ 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).:
a (_) 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. , 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:
:.may
insurance carrier and policy.number are:
Carrier STATE FUND Policy Number 0460004815
1 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 th abor Code, I shall forthwith comply with those provisions.
aD te: /Z)21 _ pplicant: (�• (/,�
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 IS100,000). IN ADDITION TO THE COST OF COMPENSATION,,DANIAGES 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 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 purposes.
Da�'' a L e
te: �f+/Z-US� ure (Applicant or Agent): � //'�
LQPERMIT 1
Application Number . . . . . 05700005414
Permit . . . ELEC-MISCELLANEOUS-
Additional desc .
Permit Fee . . . . 283.50 Plan Check Fee
70.88
Issue Date Valuation . . . .
0
Expiration Date 6/10/06
Qty Unite Charge 'Per
Extension
BASE FEE
15.00
1.00 37.5006 EA ELEC SVC <=600V/>200A/<=1000A
37.50
21.00 11.0000 EA ELEC MISC
231.00
------------------------------------------------------------------------
Special Notes and Comments
ELECTRICAL SITEWORK FOR TEMPORARY (2+
YEARS) CLUBHOUSE COMPRISED OF
COMMERCIAL COACHES. SCOPE OF WORK:
EXTEND POWER FROM EXISTING SERVICE TO
NEW 800 AMP DISTRIBUTION PANEL AND 21
SUB -PANELS.
Fee summary. Charged Paid Credited
Due
Permit Fee Total 283.50 .00 .00
283.50
Plan Check Total 70.88 .00 .00
70.88
Grand Total 354.38 .00. .00
354.38
gem '
• s
LQPERMIT
Bin#
City of La Quinta.
Building a Safety Division ✓t
P.O. Box 1504, 78-495 Calle Tampico
La Quinta-Cd7 92253 - ( 60) 777-:7012--1
Building Permit Application and' Tracking Sheet
'7vw�e,7z:iD
Permitfl
05
Project Address: 7 7,,
*, - hoflg�
Owner's Name:
JA
A. P. Number:
Address: -T7,7-50 Ave-4
Legal Description:
City,'ST; Zip:,
Contractor: ucc`
Teleph§ne
Address: Av*1�1-- .41
Project Description:
City, ST, Zip:
z L-,,, ep-" DaA
A-qzz
e5, 63
) rjdAi Qr
Telephone: '164 7 Z `R96
State Lic. #:
City Lic. #:
LJ )A I-(C47 J6E I
Arch., Engr., Designer,
Address:
City, ST, Zip: 7Z21
Telephone: b = 1 3
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle .one):New Add'n Alter Repair Demo
Sq. Ft.: igi # Stories: # Units:
Telephone # of Contact Person: s S
Estimated Value of Project: Sn
APPLICANT: DO NOT WRITE BELOW THIS LINE
ii
Submittal
Req'd
Rec!d
TRACKING
PERMIT FEES
Plan Sets
a
Plan Check submitted
I IIa3
item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Caics.
Plans Picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2"' Review, ready for correctionis A5ne
Electrical
FiCV64
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE.:-
"d 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
0
e.h.
4 1
rzo S
.
► c. AFPA
r
t ,k ,
31
.S.
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