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RC (05-0326)56850 Madison St 05-0326 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 x Q.: Application Number . . . . . 05-000.0-0-3-2Date 1/31/05 Property Address . . . . . . 56850 MADISON ST APN:'762-300-034- Application description .- REMODEL - COMMERCIAL q Property Zoning . . . . . . .. LOW DENSITY RESIDENThAL Application valuation 9000, Owner Contractor -------------------------------------------- - - - - PGA WEST FAIRWAYS ASSN EDWARDS CONSTRUCTION, BOB C/O CYNTHIA ZAMOREZ 51455 DESERT CLUB DRIVE 51905 AVENIDA BERMUDAS LA QUINTA CA 92253 LA QUINTA CA -92253 WCC: VIRGINIA SURETY WC: 00500027012 01/01/06 CSLB: 684857 03/31/06 CCC: B Other struct.info CODE EDITION 2001 ---------------------------------.------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 108.00 Plan Check Fee 70-.20 Issue Date.. Valuation . . . . 9000 Qty Unit Charge. Per Extension BASE FEE' 45.00 7.00 9.0000 THOU BLDG 2,001-25,000 63.00 ---------------------------------------------------------------------------- Special Notes and Comments REPAIR OF DAMAGED ENTRY GATE TRELLIS/R8PLACE 6X14 BEAM WITH 4X4. LATTICE. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM 1.89 Fee summary Charged Paid Credited Due ------------------------------------------------------- . .Permit Fee .Total 108.00 .00 .00 108.00 Plan Check Total 70.20 00 .00. 70.20 Other Fee Total 1.89 .00 .00 1.89 Grand -Total 180.09 .00 .00 180.09 P.O. BOX 1504 , 78-495 CALLS TIMOR 0 VOICE (760) 777-7012 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 9225344 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: C2Q 2 .T L Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.. t3UILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under Iffinalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals code a0d, ,my_Licens i full force and effect. _i / 1 /1 S i -I OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 a signed statement that he or she is licensed pursuant to the provisions of the Contractors' 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 ($500).): U 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 or 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 or she did not build or improve for the purpose of sale.). U I, 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.). U I am exempt under Sec. , B.& P.C. for this reason Date Owner WORKERS' 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 whlc tjthis permit is issued. 1 have and wiJt" intai workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is _tissued. M(c worke envy mai, in me pertormprice of the work for which this peRnit'is'issued, I shall not employ any person in any manner so as to become subject to the workers' compensationlaws of C lifo and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with tho prov ions. ,7 WARNING: FAILURE TO SECURE WORKERS' 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. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit 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 Ouinta, 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 to61 Ilation. I certify at Ithveread this application and state that the abov info aeoni co gree to comply with all city and county ordinances and state laws relating to building construc 'on,d hereby authorize representatives of this couty to nt upo a e -m ned property f inspection purposes. 6Sr Date Signal (Applicant or Agent):