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BLCK (05-1557)52170 Avenida Madero 05-1557 i S .d CSF, ppCE Ep?' y '1 .. r • ' kation Number-• O5--0" 001_55 7. -` Date 4/25/.05 Property Address . . . . . . 52170 AVENIDA MADERO APN: 773-203-009-9 -000000- Application description WALL/FENCE Property Zoning . . . . . . .COVE RESIDENTIAL Application valuation 525 Owner ;Contractor ---------------------------- -- ----- - - - - -- -- SCHUMAKER CAROL.D SUNDOWN+ CONSTRUCTION, INC. 52170 AVENIDA MADERO 79733 DANDELION DRIVE LA QUINTA, CA 92253 LA QUINTA, CA 92253 (360) 000-0899. WCC: STATE FUND WC: 57990804 07/01/05 CSLB: 792208 03/31/07 ---------------------------------------------------------------------------- CCC: B C8 C15 C54 i S .d P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 05 - 15 $ % I .' Date: 1 &f - oZs' 0 X— Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: 1, , - Lic. No.: BUILDING PERMIT DECLARATIONS 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 / Cop, and License is in full force and effect. cense Class ✓License No. J G. 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 fora 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 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. , BA P.C. for this reason Date 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 which this permit is issued. 1 have and will maintain workers' copensation ' surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ifsued. yly worlds' compe safi�on in r carrier a oticy numbgrare: arrier �'�� .-��" �Licy Number YyXI certify that, in the performan a 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 shall forthwith comply with those provisions. 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 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 count enter upon the abov d prop for inspection purposes. ate gnature (Applicant or Agent): t-- --- -------=------ Application Number 05700001557 - Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 17:00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 525 Expiration Date .10/22/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 2.0000 HND BLDG 501-2,000 2.00 ---------------------------------------------------------------------------- Special Notes and Comments .21 L.F. 6' GARDEN WALL, CITY STANDARD Fee summary Charged. Paid Credited Due Permit Fee Total .17.00 .00 .00 17.00 Plan Check Total .00 .00 :00 .00 Grand Total 17.00 .00 .00 17.00 I•Bin # Permit # Project Address: 1z a• ' A. P. Number: Legal Description: Contractor: Address: 33 Cit)" ST, Zip: [ nc, Lt 4 TelP e hone: l 7 nn 14 i c 64 State Lic. # : .-? I Z2p Arch., Engr., Designer: Address: Cite, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Cates. Truss Calcs. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed II.O.A. Approval IN IIOUSE:- Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building 81• Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: S r c 'Address: City, ST, Zip:L c ` t 0.u. Telephon -")6 S 6t 0 IOk\ Project Description: 6. i C- (I- 2— Lic. Lic. #: ......... ... . ........... Construction Type: r J ect Pe (circle or :e1 Sq. Ft.: 12- # Stories: Estimated Value of Projec APPLICANT: DO NOT WRITE BELOW THIS LINE 'd Rec'd TRACKING Plan Check subm'st! d Reviewed, ready for corrections Called Contact Person Plans picked up Plans resubmitted 2nd Review, ready for corrections/issue Called Contact Person Plans picked up Plans resubmitted ''d RevieN•, ready for corrections/issue Called Contact Person Date of permit issue ..era @Y Occupancy: Add'n Alter Repair Demo # Units: PERMIT FEES Plan Check Deposit Plan Check Balance Construction Mechanical Electrical Plumbing S. M.I. Grading Developer Impact Fee A.I.P.I'. Total Permit Fees Amount f ;.