AR (07-1235)51425 Madison St
07-1235
P.O. BOX 1504
—78-495 CALLS TAMPICO,
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning: "
Application valuation:
Applicant:
07-00001235
51425 MADISON ST
777 -030 -004 -
ADDITION - RESIDENTIAL
VERY LOW DENSITY RES
12-120
T4ht 4 4 Qum&
Architect or Engineer:
P I Of
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
STEARNS GEORGE P
51-425 MADISON ST
LA QUINTA, CA 92253
D
Contractor:
SHIVELY CONSTRUCTION 1
~ — PO BOX 1096.
LA QUINTA, CA 92247
(760)275-4333
Lic. No.: 440810
-----------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with _
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B - License No.: 440810
ate4 ractor.
. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason.(Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file 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 155001.:,
(_ 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 .
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 of she did not build or
improve for the purpose of sale.).
1 _ 1 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.).
(_ 1 I am exempt under Sec. , B.&P.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:
LQPE%MIT
VOICE (760) 777-7012 .
FAX (760) 777-7011
INSPECTIONS (760Y777-7153
Date: 4/24/07
AA
D-
JA 2 2007
CI®
VIIAIAhe^- UI NTA
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.
.1X 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.
insurance carrier and policy number are:
Carrier CLARENDON INS Policy Number 09KR0016704
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California, -
/ and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Cod/e,)I shall forthwith comply with those provisions.
Date:
WARNING: FAILURE TO SECURE WORKS S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
,DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND -ATTORNEY'S FEES. .
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for apermit 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 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
permit to cancellation. -
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the ove-mentioned property for inspection purposes. \r -
D Si ture (Applicant or Agent):
Application Number .
. . . . 07-00001235-
7-00001235Permit
Permit. . . BUILDING PERMIT
Additional desc .
Permit Fee . . . .
144:00
Plan Check
Fee ...
93.60
Issue Date
Valuation
12120
Expiration Date
10/21/07
Qty' Unit Charge
Per
Extension -
BASE FEE
45.00
11.00 9.0000
THOU BLDG 2,001-25,000
99.00
Permit ELECT _ ADD/ALT/REM
Additional desc .
Permit Fee
20.25
Plan _Check
Fee
5.06
Issue Date
Valuation
. . .
0
Expiration Date
10/21/07
Qty Unit Charge'
Per
Extension
'BASE FEE
15.00
150.00 .0350
ELEC NEW
RES.- 1 OR 2 FAMILY
5.25
Permit . . . GRADING PERMIT
Additional desc .
Permit Fee
15.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
0
Expiration Date
10/21/07
Qty Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
• Permit . . . MECHANICAL
Additional desc .
Permit Fee
24.00
Plan Check
Fee..
6.00
Issue Date
Valuation'
0
Expiration Date
10/21/07
Qty.. Unit. Charge
Per
Extension
BASE FEE
1.5.00
1.00 9.0000
EA MECH APPL
REP/ALT/ADD
9.00
Special Notes and'Comments
revisions while under
construction
addition of additional
150 sq.ft.
Other Fees
ENERGY
REVIEW FEE
9.36
LQPERMIT - -
Application Number.
. . . . .
07-00001235
Other Fees . .
. . . .
STRONG MOTION
(SMI) - RES
1.21
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
203.25
.00
.00
203.25
Plan Check Total
104.66
.00
.00
104.66
Other Fee Total
10.57
.00 -
.00
10•.57
Grand Total
318.48
.00
.00
318.48
LQPEPWIT
-