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F P.O. BOX 1504 VOICE (760) 777-7012
f 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
- BUILDING PERMIT
Date: 2/16/07
Application Number: 07-00000512 Owner:
Property Address: 51368 MARBELLA CT TOLL CA V A
APN: 772-250-998-48 -31349 — C/O KEVIN D DUERMIT
Application description: ELECTRICAL 8901 E MOUNTAIN VIEW 2I+
Property Zoning: LOW DENSITY RESIDENTIAL SCOTTSDALE, AZ 85258 FEB0)
Application valuation: 500 CI} L 1 (
Contractor: ill
CITY OF LA QUINTA
Applicant: Architect or Engineer: TOLL BROS, INC. EB FINANChDEPT.
14350 NORTH 87TH ST, STE #310
`_`fx` SCOTTSDALE, AZ 85260
+, /Pc (760)674 9699
.) I Lic. No. : 777699
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: B License No.: 777699 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
!r issued.
mate: 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 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 ZURICH AMERICAN Policy Number WC3 87 8213 01
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 L r Code,I shall forthwith 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(85001.: •;ie. pplicant:
( 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: FAILURE 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(S100,000). 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
( I 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 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 have 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 county ordinances and state laws relating to building construction,and hereby authorize representatives
of this c. ty to enter upon t above-mentioned property for inspection purposes.
Lender's Name: 10
❑ Si ure(Applicant or Agent):
Lender's Address:
LQPERMIT
1
Application Number 07-00000512
Permit ELEC-TEMPORARY POWER
Additional desc .
Permit Fee . 30.00 Plan Check Fee _ _ .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 8/15/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
Special Notes and Comments
TEMP POWER POLE AT LOT 48
Fee summary Charged Paid Credited Due
Permit Fee Total 30.00 .00 .00 30. 00
Plan Check Total .00 .00 .00 . 00
Grand Total 30.00 .00 .00 30. 00
LQPERMIT