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BRES2014-115178-495 CALLE TAMPICQ. LA QUINTA, CALIFORNIA 92753 4 4v aui�w r' COMMUNITY DEVELOPMENT DEPARTMENT J" Application Number:' BRES2014-1151 Property Address: 53551 ROSS AVE APN:' 767680039 Application Description: 5944 SF. RESIDENCE Property Zoning: Application Valuation: $536,596.50 Applicant: BRADSHAW CONSTRUCTION INC 46-248 ROUDEL LANE LA QUINTA, CA 92253 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 Professions Code, and my License is in full force and effect. License Class: 8 License No.: 848057 / Date: ' Contractor: / OWNER -BUILDER DEC RAT N I 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 applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollar ($500).: I ),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 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.). ( 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 Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/9/2015 Owner: SURES, JONATHAN & MOLLY 9336 CIVIC CENTER DR BEVERLY HILLS, CA 90210 Contractor: BRADSHAW CONSTRUCTION INC 46-248 ROUDEL LANE LA QUINTA, CA 92253 (760)347-4246 Llc. No.: 848057 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate cf 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 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 insurance carrier and policy number are: Carrier: Policy Number: _ 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply with those {provisions. e ,gate: 'J '� Applicant: _ a WARNING: FAILURE TO SECURE WORKERS' CO PENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES 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 Building Official 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 construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. j / n Date: ' ( Signature (Applicant or Agent) FINANCIAL • ' + • 4 w :DESCRIPTION ',ACCOUNT '- QTY AMOUNT. PAID• PAID DATE ART ISN PUBLIC PLAF, S r SIDENTIAL 270-0000-43201 0 $841.49 $0.00 PAID,BY ., ".METHOD '' ~' 'RECEIPT # n `CHECK # CLTD BY. Total Paid forART IN PUBLIC PLACES - AIPP: $841.49 $0.00 " '',r DESCRIPTION '' :' i' 'ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $22.00 $0.00 ' PAID BY : . METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $22.00 $0.00 .'DESCRIPTION.- ACCOUNT QTY ." AMOUNT '. PAID ` PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 PAID BY' METHOD RECEIPT'# CHECK # CLTD BY , •DESCRIPTION ACCOUNT- QTY AMOUNT . ` PAID a PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $0.00 PAID BY ' �. r;. METHOD _RECEIPT # = CHECK # . CLTD BY -, ,' • DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 PAID BY '' METHOD, RECEIPT # CHECK # CLTD BY + DESCRIPTION.. ACCOUNT .:', QTY; AMOUNT PAID ". PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 PAID`BY. METHOD _ RECEIPT # CHECK # CLTD BY , DESCRIPTION ACCOUNT ` ' QTY' AMOUNT PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $0.00 „ PAID BY s 'METHOD RECEIPT # CHECK # CLTD. BY JDESCRIPTION t ` ACCOUNT," - QTY` AMOUNT. PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 ' PAID.BY - METHOD _ RECEIPT# < CHECK # CLTD BY DESCRIPTION -: ACCOUNT;. QTY AMOUNT .PAID PAID DATE. DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $0.00 '�` ;• PAID,BY' ' METHOD} s ? RECEIPT # -CHECK # CLTD BY DESCRIPTION ACCOUNT Qfy-,PAID _ PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 PAID'BY ' ' ` ax ''-'METHOD ;, ;RECEIPT # CHECK # CLTD BY Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 a =DESCRIPTION - :,. 'ACCOUNT' ., ', .QTY :` .AMOUNT, PAID =PAID DATE TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 PAID'BY° METHOD RECEIPT# CHECK# 4' .. CLTD BY' s DESCRIPTION ACCOUNT -QTY' .5 AMOUNT PAID PAID DATE: TEMP POWER SERVICE PC 101-0000-42403 0 $16.92 $0.00 PAID6Y,' METHOD;RECEIPT #' CHECK #. CLTD BY Total Paid for ELECTRICAL: $41.09 $0.00 DESCRIPTION ACCOUNT " QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $86.31 $0.00 'PAID.BY 4 ; METHOD' RECEIPT # ••` - CHECK # CLTD BY :DESCRIP•TION- . ACCOUNT QTY AMOUNT `. ' -. 'PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 •$35.56 $0.00 '- —PAID -BY - - . ' ' METHOD,• ` RECEIPT # ' CHECK# CLTD BY DESCRIPTION ACCOUNT QTY :AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $0.00 y` x. PAID BY ; METHOD RECEIPT CHECK #' `CLTD BY - 'DESCRIPTION ACCOUNT- QTY. AMOUNT -'PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $0.00 PAID BY - METHOD " a RECEIPT # - CHECK # ` :CLTD BY Total Paid for ELECTRICAL - NEW CONSTRUCTION: $314.76 $0.00 DESCRIPTION , ` ACCOUNT QTY• AMOUNT PAID, PAID DATE RESIDENTIAL FINISH GRADING PC 101-0000-42600 0 $143.00 $0.00 PAID BY ; ., METHODRECEIPT #, CHECK # CLTD_BY Total Paid forGRADING: $143.00 $0.00 DESCRIPTION' ACCOUNT' '' QTY AMOUNT „ PAID PAID DATE, CONDENSER/COMPRESSOR 101-0000-42402 0 $181.30 $0.00 PAID, BY METHOD ` ' ."'RECEIPT #: y CHECK #` CLTD BY DESCRIPTION 'ACCOUNT', - QTY', AMOUNT PAID "PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $120.85 $0.00 PAID BY METHOD .' , RECEIPT # , :' CHECK # . , CLTD BY