06-1158 (AR)0%
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tiht 4 4 Q"
Application Number: 06-00001158
Property Address: 78355 CLARKE CT
APN: 643-70 -999-26 -31348 -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4351 `
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
b1N�� -loyN'� MADISON DEVELOPMENT
�0��� 78370 HIGHWAY 111 STE 200
LA QUINTA, CA 92253
I hereby affirm under penalty,6f perjury t t I am nsed under rovisio of Chapter 9 fcommencing with
Section 7000) of Division 3 f the Busine sand Pro ionals��Co e, d my License is in full force and effect.
License Class: B Licens o.: 588920
Date: Co ractor. \ �'
I hereby affirm under penalty of perjury th5t I am exemptf om th Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions ode: city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, n 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 70001 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.).
(_ 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 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:
LQPERI%11T
Contractor:
J ASARO BUILDERS, INC.
42220 GREEN WAY, H
PALM DESERT, CA 92211
(760)776-0043
Lic. No.: 588920
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/25/06
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.
_ 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 )icy Number 229002420506
I certify that, in the an of the ork for which this per r it is issued, I shall not employ any
person in any nner s a to become bject t t e w ers' compensation laws of California,
and agree tha , if I shoul ecome subject the w rs' compensation provisions of Section
.,,3,7/00 of the abor Code, shall forthwith co I ' h those provisions.
Date: ��►C.�_ Applic nt: --
WARNING: FAILURE TO SEC RE WO RS' COMPENSATI ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA ENALTIES AND Cl IL S UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION 0 THE COST OF CO P SATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND AT NEY'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 omissio relate o the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application b s null and void �f ork is not commenced
within 180 days from date of issuance of such ermit, cessation of rk for 180 days will subject
permit to cancellation.
I certify that I have read this application and stanattheove informatio 's co a t. I agree to comply with all
city and county ordinances and state laws relatconstruction, an re a thorize representatives
of this county to enter upon the above -mention inspection purposDate: 2 f7 Signature (Applicant or Ag
Application Number . . . . . 06-00001158
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 72.00 Plan Check
Fee
46.80
Issue Date . . . . Valuation
. . . .
4351
Expiration Date 4/23/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
27.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
} Permit Fee . . . . 19.44 Plan Check
Fee
4.86
Issue Date . . . . Valuation
0
Expiration Date 4/23/07
t
Qty Unit Charge Per
Extension
BASE FEE
15.00
222.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
4.44
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Special Notes and Comments
GARAGE ADDITION PLAN F-2 222 SQ.. FT.
GARAGE ADDITION.October 25, 2006
9:43:50 AM jjohnson
----------------------------------------------------------------------------
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