07-0705 (ELEC) „ ie....ay/ 44 au i 1 4111.
r ' 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: 3/07/07
Application Number: •7-00000705 Owner:
Property Address: ” 1100 AVENIDA VILLA- BORREGA RESORT HOLDINGS LLC
APN: 773-076-004- - - 520 SW YAMBIL WEST
Application description: ELECTRICAL PORTLAND, OR 97206
Property Zoning: VILLAGE COMMERCIAL
Application valuation: 1300
Contractor: '. 1411 Applicant: Architect or Engineer: WASSERMAN CONSTRUCT S. INC, RA
P.O. BOX 5909 7 }
LA QUINTA, CA 92247 MAR ')8 '200/
(760)771-8191
Lic. No. : 681660 CITyOFCACiit1IlpTA
FINANCE DEpL
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 Professional 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 C ss. B tense No.: 681660 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
o[ _ 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-8U DER 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 756-0000002
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 bec me subjec 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 Labor Co ,I s I forthwi 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars 05001.: .Date: . 'ant:
1 1 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 KE COMP SATION 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(5100,000). 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 exclusivelycontractingwith licensed contractors to construct the project(Sec. IMPORTANT Application is herebymade to the Director of Buildingand Safetyforapermit subject to the
P P Y� PP1
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 have read this application and state that the above information is c❑ ect" I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and cou ty ordinances and state laws relating to builds constructs n,and h eby authorize representatives
of thi nu y to enter upon Or above-mentionedor apart or(nspe . n pu es
Lender's Name:
Oat „ SI t 5ture(Applicant or Aflent):
Lender's Address: r y
LQPERMIT
Application Number 07-00000705
Permit ELEC-TEMPORARY POWER
Additional desc .
Permit Fee . . . 30.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/03/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
Special Notes and Comments
ONE TEMP POWER POLE
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
# City of La Quinta
Building at Safety Division
Permit# ?-� P.O. Box 1504, 78-495 Calee Tampico
la Quinta, CA 92253-(760) 777-7012
it Building Permit Application and Tracking Sheet
Project Address:- i/—/ V e.,r); (Q. V i#4, Owner's Name:Gov if &Corti lit
A.P.Number Address: 52,0 St O et ►� 1 t�[k:g,1
Legal Description: may,ST,Zip:Ab-rifLecrwt Or-' I WO
Contractor. R Naikssei,,,a,A'�n j Teh� 5 03 4[Y_�3 ?i'D c is"'_::.: .;�w_ _ .
Address: `�1 o c ( �@ •�• Project Description: T-'r Aouicir dd�
City,ST,Zip:Zia0. __` (:),NtEj
Telephoner��2 l,Tic,
State Lic.#: LSL�10 - City Lic.#:II a3 j ' •• .
Arch.,Engr.,Designer: -
Address:
1
City,ST,Zip:
Telephone: - _ --- Construction Type: Occupancy:
i State Lie.#: _ = Projecttype(circle mac) New Add'n Alta Repair Demo
. Name of Contact Person: - Sq.Ft: -' #Stories tI1#Units:
Telephone#of Contact Person: Estimated Value of Project: t
G w
•
APPLICANT: DO NOT WRITE BELOW THIS LINE
f
# Submittal Req'd Reed - TRACI�tG. - - PERMIT FEES
.
Plat Sets Plan Cheek submitted Item Amount
Structural Cates. • Reviewed,ready for corrections Plat Check Deposit
Truss Cala. Cased Contact Perrot Plan Check Balance
Energy Caks. Plans(nicked up Consti-udlot -
Flood plain plan , L Plans resubmitted —+ Mechanical
—
. - Grading plan' ri Review,ready for eorredlotrfisrae Electrical
Subcontactor lid - - Cased Contact Person Plumbing -
Grant Deed Plans picked up S.M.L
• - 1 -H.O.A. -
Approval Plans resubmitted - Grading
IN HOUSE:- r.a Review,ready for.eorrectiousfssue Developer Impact Fee
Planning Approval Caned Contact Person A.LP.P.
Pub.Wks.Appr Date of permit issue •-
School Fees
Total Permit Fees 41e2-----