SOTB (05-2996)57325 Madison St Lot G
05-2996
P.O. BOX 1504 VOICE (760) 777-7012
p 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
_ y Date: 11/01/05
Application Number: •05-00002996> Owner:
Property_ Address: 57325 MADISON ST LOT G D PUERTA AZUL PARTNERS
APN: 762-240-003-G -300961- 17700 SW UPPER.BOONES FERRY RD
Application description: STRUCTURES OTHER THAN BUILDIN S SUITE 100
Property Zoning: MEDIUM DENSITY RES Nov PORTLAND, OR 97224
Application valuation: 320.0
CFpyContractor:
Applicant: Architect,or Engineer: QA& Q11 RIPARIAN ENVIRONMENTS
WCC: STATE FUND
WC: 1769754-2005 05/01/06
-CSLB: 839002 05/31/06.
• v vl fit/
---------------------- ---------------------------
LICENSED CONTRACTOR'S DECLARATION
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: License No.:
fv,T Contractg ,
OWNER -BUILDER DECLARATION
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 a 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 ($500).:
(_) I, as owner of the property, or my employees withwages 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 or she did not build or
improve for the purpose of sale.).
(_ 1 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.). '
(_) 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:
LQPERMIT
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.
n I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
fT Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier C8 C27 C29 C53 Policy Number - - - - - -- - - - - --
_ 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 Code, I all forthwith comply with those provisions.
D te: . . SAPPlicant:
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 THE1ABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 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 cou to enter upon the above-mentioned pr rN for inspection purposes.
Date: L J Signature (Applicant or Agent):
Application Number- 05-0000299.6
Permit ... BUILDING PERMIT
Additional desc "
Permit Fee 19.00 Plan Check
Fee
12.35
Issue Date . . . . Valuation
700
Expiration Date 4/30/06.
Qty Unit Charge Per
Extension
BASE FEE
15.00:
2.00 2.0000_ HND BLDG 501-2,000
4.00
"Permit BUILDING PERMIT
Additional,desc .
Permit Fee 54:00 Plan Check
Fee
35.10
Issue Date Valuation
2500
Expiration Date 4/3'0/06
Qty Unit Charge .Per
Extension
BASEFEE
45.00
1.00 9.00.00 THOU BLDG 21001-25'000
9.00.
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 15.45 Plan Check
Fee
3.86
Issue Date Valuation '.
0
Expiration Date 4/30/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 ..4500 EA ELEC DEVICE/FIXTURE >20
.45
Permit PLUMBING
Additional desc.
Permit Fee— 18.00 Plan Check
Fee
4.50
Issue Date Valuation "".
0
Expiration Date 4/30/06
Qty Unit Charge. Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE.1-4 OUTLETS
3.00.
-----------------------------
Special Notes and Comments
WATERFEATURE; 28 L.F. 6' TO 8' -BLOCK
e
WALL, ORCO SYSTEM; & 2 COLUMNS.
------------.------------------.-----------
Other Fees ENERGY REVIEW FEE
4.75
LQPERMIT
Application Number
. . .
05-00002996
Fee summary
Charged
Paid
Credited
Due
-- - --
Permit Fee Total
---- - - - - --
106.45
---- - --- --
.00
---- - - - - -------
.00
--- ---
106.45
Plan Check Total
55.81
.00
.00
55.81
- Other Fee Total
4.75
.00
.00
4.75
Grand Total
167.01
.00
.00
167.01