07-2888 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
07-00002888
Property Address:
80750 AVENUE 58
APN:
762-240-014-A -34243
Application description:
ELECTRICAL
Property Zoning:
RL AG/EQ OVERLAY
Application valuation:
3200
Applicant,
------------------------
LICENSED CONI
I hereby affirm under penalty of perjury that I am li ensed i
Section 7000) of Division 3 of the, Byglnetcynd P fe�r
License Class: B
e
Date: / - Contractor:
Architect or Engineer:
Nlk
I'S DECLARATION
,visions of Chapter 9 (commencing with
, and my License is in full force and effect.
No.: 763187
ION
I hereby affirm under penalty of perjury that I3JNER-tBIUIyD.1theDECLARAT
empo Contractor's State License Law for the
following reason (Sec. 7031.5, Business andsions CoAny city or county that requires a permit to
construct, alter, improve, demolish, or re4L 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).:
(_) 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, 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 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:
LQPERMIT
Owner:
MADISON 58TH LA QUINTA,
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor:
INNOVATIVE COMMUNI
1282 PACIFIC OAKS
ESCONDIDO, CA 9202
(760)690-5200
Lic. No.: 763187
LLC
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS �760) 777-7153
Date: 11/02/07
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 w ch this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Nu er 756-0000304-07
_ I certify that, in the performance of I work or whi this permit is issued, I shall not employ any
person in any manner so as to b ome su iect to a workers' compensation laws of California,
and agree that, if I s or suc to the orkers' compensation provisions of Section
3700 of the La r Co e all rth th com with those provisions.
Date: Applicant
WARNING: FAILURE TO SECURE WORKEP4'qOMPENSVTION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P LIES ANq CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, EST, 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 v . if w k is not commenced
within 180 days from date of issuance of such permitJ
ssati of wor for 180 days will subject
permit to cancellation.
1 certify that Ihave read this application and state that the above inion correct. I agree to comply with all
city and county ordinances and state laws relatin stn, a d hereby uthorize representatives
of this county to enter upon the above -mentioned property for ' ppu oses.
Date: w U,(, ! Signature (Applicant or Agent):
Application Number . . . . . 07-00002888
Permit . . . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33.50
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . . 4/30/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC
----------------------------------------------------------------------------
SVC <=600V/<=200A
18.50
Special Notes and Comments
ELECTRICAL PEDESTAL 200 AMP 50 FT
FROM
ENTRY GATE
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 33.50
-----:----
.00
----------
.00
33.50
Plan Check Total .00
.00
.00
.00
Grand Total 33.50
.00
.00
33.50
LQPERMIT