06-4023 (ELEC) (=city/ 4
e„Qiitht I i IIIN
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: 11/20/06
Application Number: 06-00004023 Owner:
Property Address: 81457 COLUMBUS WY EAST OF MADISON LLC
APN: 767-200-998-I -330762- PO BOX 1482
Application description: ELECTRICAL LA QUINTA, CA 92247
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1200 1 A I
10
Contractor: 2U06 Applicant: Architect or Engineer: COCHRAN COMMUNCATION .CO��T IN(4Q� 2 2 [ U
36630 CATHEDRAL CANYON t-I E •
1)1 K CATHEDRAL CITY, CA 9223• C17 YOF�Qfi1lRA
(760)328 6778 ��
FI CED •
Lic. No. : 478543
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I 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: C7 License No.: -7 8 S 4:3 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
Date:/f �/� issued,
` Z Contractor: /� 1 �� V I have and will malmain 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 insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 046-0008625
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I-certify that,in the performance of the work for which this permit is issued,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any manner so as to become subject to the workers'compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should become subject to the workers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the La ode,I shall fort Ith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �r _47-v •�J
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(55001.: eat scant: I��
( I 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 WARNING: FAIL E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
( 1 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application. .
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_I I am exempt under Sec. ,B,&P.C.for this reason 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.
Date: . Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I•h e•read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and y ordinances and state laws relating to building construction,and hereby authorize representatives
Lender's Name: ,1 r)/ ^ of thl •urrry to enter upon She a m bove- entionod.property for inspe - n pur ses.
11/4_7 I)�t' Rate:/I-a Z Sign a fAppricant or Agent}:
Lender's Address:
LQPERMIT
Application Number 06-00004023
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . 33.50 Plan Check Fee . . . 00
Issue Date . . _ _ Valuation . . . . 0
Expiration Date . . 5/19/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
100 AMP METER PEDESTAL BETWEEN LOTS 16
-17
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
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COCHRAN COMMUNICATIONS CONSTRUCTION
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Ave 52 Cathedral City, CA 92234
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Bin # vNIA-��� City of La Quin
Building & Safety Division
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1 ' 1� P.O. Box 1504
Permit it 78-495 Calle Tampico
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Project Address: O - Li 5 7 Owner's Name: T/AIL n/,415/'ff J' CAD IL
A. P Number: Address: t/T25 C 0 D K 37
Legal Description: City,ST,Zip:f4 LN DfSEif.T 92 E [J
Telephone:. 'O -L..9 LZ
Contractor: COC�RA IICQ MN C ONS T [
Address: ,36- 6'SC Ch T1-1F,D# 4L CYN Project Description:
Citv.ST,Zip: CA l h'ED fill-L CITY 9223 £- 100 AMP MF_ TEI PE17LSTA L.
Telephone: SS 3 - 6' 776
State Lic. # :I/ 7B5 ii 5 City Lic.#: 8 0 S
Arch.,Engr..Designer:
Address: I
City, ST,Zip:
Telephone: Construction Type: ,41 Occupancy: A/A
State Lic. #: Project type(circle one): New Add'n Alter Repair Demo 1
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Ft.. #Stories: #Units:
Name of Contact Person:�,�°/ �we.") S9•
Telephone#of Contact Person: 7(00- 2-g-°' .,l 7 Z;._ Estimated Value of Project: T /2 0 D —
APPLICANT: DO:.NOT'WRITE SELOW TM;6NE'
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