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05-5107 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tjht °F�Q�w Application Number: 05-00005107 Property Address: 52595 MERIWETHER WY APN: 767-200-998-K -330762- Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 27370 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA,'CA 92247 Contractor Owner A --------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I I hereby affirm under penalty of per Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintai License Class: License No.: — f S Date: Contractor: • OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that,l 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 thathe 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).: XI, as owner of the property; or my employees with.wages as their sole compensation, will do the work, and l7�_ 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.). ,PR(ir' 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 contractorls) licensed pursuant to the Contractors' State License Law.). ' (_ )' I am exempt under Sec. , B.&P.C. for this reason Date:,"' —S—Db Owner: CONSTRUON LENDING AGENCY I hereby affirm under penalty of perjury that there is a conduction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERA11T VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/03/06 jury one of the following de_cralratiotl;1 n a certificate of consent to self -insure for workers' compensation, as provided or by ection 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 surance carrier and policy number are: Carrier �� Policy Number _ I certify that, in the performance of the work for which this permit is issued, I s all not employ any person in any manner so as to become subjec the workers' compensation laws of California, and agree that, if I should become subject the orkers' compensation.provisions of Section 3700 of the Lab o ode I sh hwit comp with those provisions. ate:4+& �licant• WARNING: FAILURE//E TO SECURE WORKERS MPENSATION COVERAGE IS UNLAWFUL, AND SHALL' SUBJECT AN, EMPLOYER TO CRIMINAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 info on is correq". gree to comply with all city and county ordinances and state laws relating to building constr ti , and 'here y au ooze representatives of this county to enter upon the above-mentioned property fq/linspe ion urposes. Application Number . . . ... 05-00005107 ' � Permit . . . . . . BUILDING eoRMrr - Additional deoc Permit nee `. . . . 543.00 Plan CheckFee ' ��6 48 ' ' _ . Issue Date . . Valuation '------~~ ' ' ' z737O �xpiratioo oate . . 7/3I/06 ' ' � ' Qty Unit Charge Per Extension BASE FEE ` 3.nV6.5OoO_TH0D_BLDG _z5,OO1_sn,Oo0_------.______l9'5O_ 5z3 5O Permit . ' . . . ' ELEC-MISCELLANEOUS �---------- Additional. �di�iooal deoo . . Permit Fee . . ' . G7.Oo gIao Check Fee 3ozaooe 8' Date . . '' Valuation OEgiratimu ' Date 7/31/06 Qty Unit Charge. Per Extension BASE FEE oo18�sVoo-EA «~6oV�/<~uOuA _____z�______ ___EL�c_SnC_ 48.50 .18.50O ——— --------------- Special ——— TEMPORARY ^ "CONCRETE -SLAB FuumuATIom-625 a9'11B" OCCUPANCY.'2001 CODES. MINOR USE eoaMzT -#2005-727. zmvoarz{ATzom FEE a0000SED PER 1997 ' omzFOaM'ADmxzmzSTRxxrzvo c0oE O304.5 FOR woaK B000m WITHOUT oDzLozm8 r�gM�r. _---_-7-------_---______--__--------_----_�----_-_--- Other-Fees ' . ' . . ' � . . SraOmG��OrzOm (SMI) - C0� -------- 5.74 Fee _summary Credited ______ Charged __ __�Paid ___ _ __Due . Permit Fee Total 610.00 `Oo OO 'Ou ___ 00 s~-�o ~'u6 Plan Cbecb'Tntal. I84.86 5O.oO 'Oo 34'74 Other Fee Total s.7« ' .o� � ' Grand Total �0O6O �5OVo . .00 ' ~' 65O.6o LQPEPAfIT i¢, of pa Qccuz a 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 TYPE FORMAT RECORD DATES TOTAL DESCRIPTION OF RECORD EXIST? RETENTION. t I certify that the records described above and approved for destruction were o recycled o shredded on as prescribed by law. i City Clerk or Deputy City Clerk Signature Type: Original Documents = 0 Copies = C Print Name Title 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