05-5106 (SOTB)4 P.O. BOX 1504 VOICE
(760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT FAX
(760) 777-7153
BUILDING PERMIT
Application Number: 05-00005106 Date: 4/03/06Owner:
Property Address: 52595 MERIWETHER WY EAST OF MADISON LLC
APN: 767-200-998-K -330762 PO BOX 1482
Application description: ' STRUCTURES OTHER THAN BUILDINGS ` LA QUINTA, CA 92247;
Property Zoning: LOW DENSITY RESIDENTIAL ------
Application Valuation: 69072
D
Contractor: 4 0
Applicant: Architect or Engineer: Owner '
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-------------.------------ -- ---APR 052006
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. LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of -perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjuryone of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: license No.: _ I have and will maintain a certificate of consent to self-irisure 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.
Date: Contractor: n I have and will maintain workers' compensation f pensation 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 C.tnsyrance carrier end policy number are: �t
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier (-L- CPolicyNumber T-'%%�/ %� .� )
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
vio a ti that, if I should become subject 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 / 3700 of the Labo^de, I sha�f7t�thwitlytro�ply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exem tion An I f S — -
p y ion o ect�on 7-...y
an npplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(i 1 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 -
ti 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 III am. exempt under Sec. , B.&P.C. for this reason - -
'
I hereby affirm under penalty of perjury that there is a cor
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERA1`IT
LENDING AGENCY
in lending agency for the performance of the
WARNING: FAILURE TO SECURt w KER MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES 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 co ction, he by authorize representatives
of -this county to enter upon the above-mentioned rt for i pec 'on p rposes
Date: t, Signator (Applicant or Agen
Application Number . . . -... 05-00005106
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . .1009.00 Plan'Check Fee
327.93
Issue Date Valuation . . .
69072
Expiration Date 7/31/06
.
Qty: Unit Charge Per.
Extension
BASE FEE
919.00
20.00 4.5000 THOU BLDG 50,001-100,000
----------------------------------------------------------------------------
90.00
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
-----------------------------
Special Notes and Comments.
TEMPORARY PRO SHOP TENT STRUCTURE W/
CONCRETE SLAB FOUNDATION. 1200 SF."M/B1,
OCCUPANCY. 2001 CODES.
MINOR USE PERMIT
#2005-727.INVESTIGATION FEE ASSESSED
PER 1997 UNIFORM ADMINISTRATIVE .CODE.
§304.5 FOR WORK BEGUN WITHOUT BUILDING
PERMIT.
------------------------ ----------------------
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Other•Fees STRONG MOTION (SMI) COM
.14.50
Fee.summary Charged Paid Credited
----------------- ---------- I
Due
---------- -------- -- ----------
Permit- Fee Total 1076.00 .00 .00
1076.00
Plan Check Total 3 ' 36.31 300.00. .00
36.31
Other Fee Total 14.50 .00 .00
14.50
Grand Total 1426.81 300.00 ..00
1126.81
LQPERMIT
I
,q o fa Q,tcuata 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
City Attorney Signature
RECORDS TO BE DESTROYED:
Print Name Department
Williamdhrke
Print Name Date
UFFS# and TITLE or E -IMAGE REQUIRED
DESCRIPTION OF RECORD
TYPE FORMAT RECORD DATES EXIST? TOTAL
RETENTION
40 `�/c.ee� div .Q%I-Usc��cK' le'a,� i-� �t'��acctcoC.
I certify that the records described above and approved for destruction were o recycled o shredded on as
prescribed by law.
City Clerk or Deputy City Clerk Signature Print Name Title
Type: Original Documents = O Format: Paper records to be shreded = P/S
Copies = C Paper records to.be recycled.= P/R
Electronic document to be deleted = E
CD, DVD, Tape to be destroyed = CDT