07-0742 (ELEC) idi
P.O. BOX 1504•
cell"iiii 4 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: 3/12/07
Application Number: 07-00000742 Owner:
Property Address: 81984 MOUNTAIN SPUR DR DESERT CHEYENNE, INC.
APN: 767-200-999-S -312021- 78401 HIGHWAY 111, SUITE G
Application description: ELECTRICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760)777-9920
Application valuation: 500
Contractor:
Applicant: Architect or Engineer: HERINGTON DEVELOPMENT, JAMES 0
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
Lic. No. : 753190 PL-----"4"---C=.11
- 2007
CiTy0F f
F7 ,
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION c" .rrPd�
I hereby affirm under penalty of perjury 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 Rusin s 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 CI s License No.: 753190 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
/Date /J II 7 dr.tractor: • 1. I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor
7 F • 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 hat I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1542746-2006
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in the perf rmance 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 manna 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 anti agree that,if I sh d 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 00 of the Labor Co ,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 t
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: D ate//3 d) A tarn:
( 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 W RKERS'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 CRIMI ' 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 ADDITIO 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,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 appli Ion becomes null and void if work is not commenced
within 180 days from date of issuance o ch 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 t trove information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and co lay or stances and state laws relating to bung construction,and hereby authorize representatives
of th'-c ty t nter upon th above-mentioned grope for inspection purposes.
Lender's Name:
stp Dale: d/ . ature(Applicant or Agent):
Lender's Address: R-
LQPERMIT
Application Number 07-00000742
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . 33.50 Plan Check Fee . _ .00
Issue Date . . Valuation . . . . 0
Expiration Date . . 9/08/07
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 LANDSCAPE PEDESTAL WITH 2 20
AMP BREAKERS
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
MAR-08-2007 THU 11 :21 AM RANCHO SANTANA FAX NO, 3987315 P. 02
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MAR-08-2007 THU 11 :20 AM RANCHO SANTANA FAX NO. 3987315 P, 01
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ofUinta
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City Quinta• Building a Safety Division
Permir# �� •� P.O. Box 1504, 78-495 Cafie Tampico
4114..
La Quinta, CA 92253-(760) 777-7012
'.0 Building Permit Application and Tracking Sheet
Project Address'.j �ati 9�,Biz . � me
Owner's Na : x _\b ee_.. (:t b
A.P.Number: -7 t p4---f5l(" ,,. •`,p_j Address:x'15- 1 ��-I,con Ck3 i 1 i • Tt `51
Legal Description; City. ST.Zip: x Lys C?'-t;,..4.11-0. ela 7 n 5
Contractor: X 1 i A D /- /ar"/ yJ Telephone: 0-777-29.3-0
Address: 4 0 9 6.0 1;F: oicitkI. R $3 Project Description: ;�C
City.ST,ZiP:1(` ifitl g i T4 64 tuts 47254..g., i t.° Alm p 61,c.. Ped ).
Telcohone: x ;
state Lie_# : x. 75,3 Oa , City.Lie.#; I • se 1 •O]cl1np 5
Arch..Engr..Designer:
Address- 7-Th4,--P111:.
n 6P -' 9-0:-/L,A, ' J
City.ST.Zip:
IJ
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Telephane; eryu, Construction Type: wie.0 pancy �
. pew
State Lie. Project type(circle onel: New Add'n Alter Repair Demo
l Name of Contact Person: vSq_ Ft.: .
'� ��-r� ��'�..� Stories; #Units:
Telephone# of Contact Person:K 1 6b-^ 51$"- -Sb Estimated Value otProject:H.
APPLICANT; DO NOT WRITE BELOW THIS LINE
it -I Submittal Req'd Rec'd TRACKING PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Cates. Reviewed.ready for corrections Plan Check Deposit
- Truss Cafes. Called Contact Person Plan Check Balance
4.
Title 24 Cates. Plans picked up Construction
Flood plain plan Plans resubmitted M11echanieal
li
Grading plan 2"Review,ready for corrections/issue Electrical
Subcontaetor List Called Contact Person Plumbing
Grant Deed Plans picked up S.M.I.
H.O.A.Approval Plans resubmitted Grading
IN HOUSE:- Ja Review,ready forcorrectionslissue Developer Impel Fee
Planning Approval _ _Called Contact Person 4_Called Y
Pub.Wks.Appr Date of permit issue
School Fees
, Total Permit Fees s-
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