05-5105 (SOTB)Y < 1: ►-
3`
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'!t °F 4 Q"
Application Number: 05-00005105
Property Address: 52595 MERIWETHER WY
APN: 767-200-998-K -330762-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 117216
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
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 pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
() 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 ownei 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, 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 am exempt under Sec. , B.&P.C. for ty-s Vason e!!�
MOV!
CONSTHbCTION 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 ISec. 3097, iv. C.).
Lender's Name: _
Lender's Address:
LQPE%NIIT .
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-------------------------- i<�-l_---APR
Date: 4/03/06
0 5 ?006
cFTY
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.
Al 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
C � Lnsurance carrier and policy number are: `n —7?1 / /� i
Carrier / J' Policy Numbery 7 / -i J
I certify that, in the performance of 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 54ject to workers' compensation provisions of Section
3700 of the Labor e, I shall fo h ith Vy with those provisions. .
Date.
5-c A plicant:
WARNING: FAILURE TO SECURE WORKERS'PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALT S 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.
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 con tion, and er by authorize representatives
of this county to enter upon the above-mentioned pr ert for ins ect n purp ses
D., f��-
D.
-0'iignatue (Applicant or Age
n
LQPERMIT
Application Number . . . . . 05-00005105 .
Permit . BUILDING PERMIT
Additional desc . . '
Permit Fee 1405.00 Plan Check Fee 456.63
Issue Date . . Valuation . . . . 117216
Expiration Date 7/31/06
Qty Unit Charge Per Extension
BASE FEE 1342.00
18.00 3.5000 THOU BLDG 100,001-500,000 63.00
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Permit . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 67.00 Plan Check Fee 8.38
Issue Date . . . . Valuation 0
Expiration Date 7/31/06
Qty Unit Charge Per Extension
BASE FEE 48.50
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
-
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Special Notes and Comments
TEMPORARY CLUB DINING TENT STRUCTURE W/
CONCRETE SLAB FOUNDATION.1500 SF W/.
1020 SF COVERED DECK. 2001 CODES
MINOR USE PERMIT #2005-727.
INVESTIGATION FEE ASSESSED PER 1997
UNIFORM ADMINISTRATIVE CODE §304.5 FOR
WORK BEGUN WITHOUT BUILDING PERMIT.
-------------------------------------------------------------------- ------
Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM 24.61
Fee -summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 1472.00 .00 .00 1472.00
Plan Check Total 465.01 400.00 .00 65.01
Other Fee Total 24.61 .00 .00 24.61
Grand Total 1961.62 400.00 .00 1561.62
r
ifLt� o f,ta Quinta RECORDS DESTRUCTION AUTHORIZATION
In accordance with the City's Records Retention Schedule as adopted by Resolution 2010-016, it is.requested that the records
delineated below be destroyed. There is no known litigation or reasonably anticipated investigation or litigation that would
require these records be held.
The total retention period has expired or in accordance with GC34090.5, any original/permanent records herein are being .
destroyed because (1) these records have been scanned into a permanent electronic format, (2) the format produced an accurate,
legible copy that does not permit edits, (3) it is accessible for public reference to the same degree as the original version, and
(4) a true, secondary electronic copy is kept in a safe and separate place.
Department Head Signature Print Name Department
William Ihrke
City Attorney Signature Print Name Date
RECORDS TO BE DESTROYED:
UFFS# and TITLE or E -IMAGE REQUIRED
DESCRIPTION OF RECORD TYPE FORMAT RECORD DATES EXIST?. TOTAL
RETENTION
710 v4t")
I certify that the records described above and approved for destruction were o recycled o shredded on as
prescribed by law. -
City' Clerk
aw.
City'Clerk or Deputy City Clerk Signature
Type: Original Documents = O
Copies = C
Print Name
Format: Paper records to be shreded = P/S
Paper records to be recycled = P/R
Electronic document to be deleted = E
CD, DVD, Tape to be destroyed = CDT
Title