08-1529 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
0'8' 0 0"O Q 15;2'9
f21L, >,
4'94"21�AVEN.I DAOBREGON
658-160-061-=' -
RE -ROOF
MEDIUM DENSITY RES
165209
T,it!t 4 4 Q"
Architect or Engineer:
�1�
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of. Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code; andmyLicense is in full force and effect.
License,Class: C39 -License No.: 819960
at ntractor. � "
' OWNER -BUILDER, DECLARATION
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 Codes Any city or -county that requires a permit to
construct, alter, improve, demolish, or repair anystructure; prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licenseb pursuant to the provisions of the Contractor's State
License Law (Chapter9 (commencing with.Section 7000) of -Division 3 of the Business and Professions Code) or
that tie 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 (S5001.:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will -do the work, and
tht 'structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
C
o
ntractors'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
-impr"ove for the purpose of sale.). '
(_ 1 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 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.I.
Lender's Name: _
Lender's Address: g
J
LQPERA11T
Owner: D
KSL DESERT RESORT
C/O CNL HOSPITALI j
450 S ORANGE AVE
ORLANDO, FL 32801
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
w Oyu
Pc` ' 0 J L73111!"
CITY OF LAF Q I TAU fVI Tq� N
Contractor: ---
DRI RESIDENTIAL CORPORATION
17182 ARMSTRONG AVENUE
IRVINE,'CA,92614
(949)266-1950
Lic. No.: 819960
9/09/08
----7-------7--------7----------------------
WORKER'S'COMPENSATION DECLARATION
I hereby affirm under penalty ofperjuryone 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.
I have, and will maintain workers' compensationinsurance, as required by Section 3700 of .the Labor
Code, for the performance o{the work for w'hic'h this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier" AMERICAN CASUAL Policy Number WC27496822.7
I certify that, in the performance of the work for which INs'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.
vete:cant:
WARNING: FAIL RE; To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN'EMPLOYER TO CRIMINAL PENALTIES AND.CIVILFINES 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 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 It i ounty to enter u on the above-mentioned grope far inspection purposes.
ate. igna a (Applicant or Agentl:
Application Number . . . . . 08-00001529
Permit . . . RE -ROOF
Additional desc . .
Permit Fee . . . . 30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 3/07/09
Qty Unit Charge Per
Extension
BASE FEE
30.00
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Special Notes and Comments
REMOVE EXISTING TILE ROOF, REPLACE ANY
DAMAGED OR ROTTED SHEATHING, RE -ROOF
WITH ORIGINAL TILE AND NEW TILE WHERE
NEEDED. PLANNING APPROVAL OBTAINED.
ESR -1489 FOR REDLAND CLAY TILE ATTACHED
TO FIRST PERMIT, #08-1523 (TENNIS
STADIUM)
Fee summary Charged Paid
Credited
Due
Permit Fee Total 30.00
.00 .00
30.00
Plan Check Total. .00
.00 .00
.00'
Grand Total 30.00
.00 .00
30.00
LQPERMIT