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08-0968 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-000009- Property Address. 52945 HUMBOLDT BLVD APN: 767-200-091-5 -34968 Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 44182 Tity/ 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 • VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/06/08 U ll'A' y tractor: Applicant: Architect or Engineer: JUN 1 3 2008 & M CONSTRUCTION +L_�IAI O. BOX 366 ^ COFLA QUINTA, CA 92247 ANCEDEpr 760) 564-4832 iC. No.: 746198 ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B C10 License No.: 746198 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: Contractor: - _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 044-0028137-07 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if ecome sub' ct to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37000 of th a or Code, I s II fo w' comply th.thos r visions. that he li she o exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by _12` N1� J any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: e: p nt: (_ 1 1, 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 WARNING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 _ 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.). (_ 1 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 perfoimance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: PIR LQPERMIT 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and herebuthorize r r sentatives ofthis county to enter upon the above -mention erty for in ec- o a7 t % 1 1 ature (Applicant or Agent): LQPERMIT Application Number . . . . . 08-00000968 •Permit BUILDING PERMIT ` Additional desc . Permit Fee 382.00 Plan Check Fee 248.30 Issue Date . . . . Valuation . . . . 44182 Expiration Date 12/03/08 Qty Unit Charge Per Extension BASE FEE '252.00 20.00 6.5000 THOU BLDG 25,001-50,000 130.00 Permit . . . ELECT - ADD/ALT/REM Additional desc *Plan Permit Fee . . . . 15.04 Check Fee 3.76 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/03/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY .04 _ -------------------------------------------- -------------------------------- Special Notes and.Comments REVISION WHILE UNDER CONSTRUCTION. ADDITIONAL 524 SF ADDED TO HOUSE AND 94 SF. TO GARAGE ----------------------------------------------- ---------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 24.83 STRONG MOTION (SMI) - RES 4.41 Fee summary Charged Paid Credited ---------------------------------------------------------- Due Permit Fee Total 397.04 .00 .00 397.04 Plan Check Total 252.06 .00 .00 252.06 Other Fee Total 29:24 .00 .00 29.24 Grand Total 678.34 .00 .00 678.34 LQPERMIT