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DEMO (05-0887)i "w Box 1504 >5 CALLE TA.MPICO UINTA, CALIFORNIA 92253 Der . . riuYei uy tiuczte5s . . . APN: Application description Property Zoning Application valuation. Owner NRI CCP I C/O NRI CCPI 81100 AVENUE 53 �F�Q�rw BUILDING PERMIT BUILDING $ SAFETY DEPARTMENT (760.) .777-7012 FAX (760) 777-7.011 INSPECTION REQUESTS (760),777-7153 05-00000887 Date 3/16/05 53555 MONROE ST 767-210-043- -000000- . . . DEMO - COMML/OTHER . . . LOW DENSITY RESIDENTIAL 0 LA.QUINTA CA 92253 Contractor ------------------------ DEMO UNLIMITED, INC. - 81750 AVENUE 50 INDIO CA 92201 (760) 775-5884 WCC: HRH INS WC: 009421-2005 01/01/06 CSLB: 473328 05/31/05 CCC: A -C21 Other struct info . . . . . NUMBER OF UNITS 2.00 ------------------------------------------------------------------'---------- Permit . . . . . . DEMO PERMIT Additional desc Permit Fee 45.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Exteris,i'`on BASE FEE 45:00 ------------------------------------- Special Notes and Comments -------------------------------------- DEMO TO BARE GROUND WOOD FRAME TRAILER - BLDG. 0. Fee summary Charged Paid Credited Due Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 ..00 .00 Grand Total 45.00 .00 .00. 45.00 :&f 4 4 P.O. Box 1504 " 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: >- / 2 D7 S. Architect or Engineer's Address: - X110 Lic. No.: BUILDING PERMIT DECLARATIONS 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 I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 1, as owner of the property, or my employees with wages as their sole compensation, will do the wok, 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 wok himself or herself or 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.). (�l' I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' 41 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.). U I am exempt under Sec. . BA P.C. for this reason ate �%b "0-S nater WORKERS' 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 wok 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 wok for which this permit is issued. My workers' compensation insurance carrier and policy number are: ,. amer 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. ate 3-Ae' :,p4cant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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. I hereby affirm under penalty of perjury that there is a construction lending CONSTRUCTION agency orVthe peAGENCYING performance of he wok for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address P 1A APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety for a 1. Pel Each person upon whose behalf this application is made, each person atwhose sequest and for hose 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 Ouinta, its officers, agents and employees for any act or omission related to the wok being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if wok is not commenced within 180 days from date of issuance of such permit, or cessation of wok 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 county to enter upon the above -mention d property for inspection purposes. Signature (Applicant or Agent): lav i, iuE ur �;�1virL l tvw THIS IS TO CERTIFY THAT AN ASBESTOS ABATEMENT. PROJECT HAS BEEN COMPLETED IN ACCORDANCE TO. SCAQMD, CAL -OSHA & EPA REGULATIONS AT: WOOD FRAME TRAILER Avenue 52 Indio, CA 0203, ` JOB # EKU-204-107-0 Asbestos abatement and disposal of friable asbestos containing materials (ACM) Approx. 45 Sq/ft linoleum per survey report number 110513 provided by Enviro-Test dated February 25, 2005., DATE January 28'2005 JOB NAME The Hideaway Project/ Demo Unlimited PROJECT COMPLETION WITNESSED BY, Beverley L Gann P.O. Box 285 • Mira Loma, CA 91.752 Phone (909) 685-5314 • Fax (909) 681-5559 O�. 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