BWFE2017-0122r
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X78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BWFE2017-0122
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address:
51425 MADISON ST
APN:
777030004
Application Description:
SOUTH WEST AND EAST PERIMETER BLOCK WALL WITH 6 PYLASTERS
Property Zoning:
Application Valuation:
$130,000.00
Applicant:
BRADSHAW CONSTRUCTION
INC
46-248 ROUDEL LANE
LA QUI NTA, CA 92253
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 Professions Code, and
my License is in full force and effect.
License Class: B License No.: 848057
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 tfie 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 li
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 Na
Lender's Address:
VOICE (7.60) 777-7125
FAX (760) 777-7011 -
INSPECTIONS (760) 777-7153
Date: 8/1/2017
Owner: -
POLO VISTA
NA
NA, CA 92253 .
Contractor:
BRADSHAW CONSTRUCTION INC
46-248 ROUDEL LANE
LA QUINTA,,CA 92253
(760)347-4246
LIc. No.: 848057
WORKER'S COMPEIISATION DECLARATION
I hereby affirm underpenalty of perjury one of the following declarations:
1 have and will maintain a certifcate 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 worker' 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 COMPENSATION INSURANCE FUND Policy Number: 9043902
_ 1 certify that in the performanceof 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.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRMINAUPENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE{OST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACF NOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this aF plication 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 apolication 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 city to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
%.
Date: 8/1/2017
t/Application Number:..
BWFE2017-0122
Owner: .
Property Address:
51425 MADISON ST
POLO VISTA
APN:
777030004
NA
Application Description:
SOUTH WEST AND EAST PERIMETER BLOCK WALL WITH 6 PYLASTERS
NA, CA 92253
Property Zoning:
Application Valuation:
$130,000.00
Applicant:
Contractor:
BRADSHAW CONSTRUCTION
INC
BRADSHAW CONSTRUCTION INC
46-248 ROUDEL LANE
46-248 ROUDEL LANE
LA QUINTA, CA 92253
LA QUINTA, CA 92253
(760)347-4246
--------------------------------------------------------------------------------------------
Llc. No.: 848057
Detail:
DESCRIPTION
ACCOUNT-
CITY
-AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$364.80
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$50.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$63.33
Total Paid for BLOCK WALL: $478.80
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$6.00
Total Paid for BUILDING STANDARDS ADMINISTRA1ION BSA: $6.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
Credit Card Fee
101-0000-43505
0
$8.82
Total Paid for Credit --ard Fee: $8.82
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for. TECHNOLOGY ENHANCEMENT FEE: $5.00