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05-2000 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05-00002000 Owner: Property Address: APN: 78415 CLARKE CT 643-170-999-32 -31348 - PH RANCH LLC 78370 HIGHWAY 111 STE 200 Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIALApplication MFINANCEDE;PT. .valuation:. 4351 Contractor: Applicant: Architect or Engine EHLINE COMPANY 55375 MEDALLIST DR LA QUINTA, CA 92253 (760) 771-8130 Lic. No.: 482086 VOICE (760) 777-7012 FAX (760) 7717-7011 INSPECTIONS (760) 777-7153 Date: 8/09/05 I i• i ---------------------------- ----------------------------------------------------------------- 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.: .482086 Date: Contractor: 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 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 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 or she did not build or improve for the purpose of sale.). ( 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.). ( 1 I am exempt under Sec. , B.&P.C. for this reason ..,Xate: W 7Ger: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perpry 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 provide'd for by Section 3700 of the Labor Code, for the performance of the work for which this permit isi issued. I 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 STATE FUND Policy Number 1814972 I certify that, in the performance of the work for which this permit is issued, I shall not" any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become su 'ect to the workers' compensation provisions of Section 14 y00 of the I comply with those provisions. >s �� ate: icant WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 19100,000). 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 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 i 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 I 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 b ' ing construction, and hereby authorize representatives] of this co my ent�pon the above-mentionMpyr i'on oses. Ciate!'nature (Applicant or Ag Application Number . . . . . 05-00002000 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 72.00 Plan Check Fee 46.80 Issue Date Valuation . . . . 4351 Expiration Date 2/05/06' Qty Unit.Charge Per Extension BASE FEE 45.00 3.00 9.0000'tHOU ---------------------=------------------------------------------------------ BLDG 2,001-25,000 27.0-0 Permit . . ELECT - ADD/ALT/REM Additional desc . Permit Fee 19.44, Plan Check Fee 4.86 Issue' Date • Valuation . . . . 0 Expiration Date 2/05/06 Qty Unit Charge Per Extension BASE FEE 15.00 222.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 4.44 ---------------------------------------------------------------------------- Special Notes and Comments addition to existing garage.August 9, 2005 10:37:44 AM jjohnson 222 sq. ft. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE. 4.68 STRONG MOTION (SMI). - RES .50 Fee summary Charged Paid Credited Due Permit Fee Total 91.44• .00 •.00 91.44 Plan Check Total .51.66 .00 . .00 51.66 Other Fee Total 5.18. .00 .00 5.18 Grand Total 148-.28 - 00 .'00 148.28 LQPERMIT