10-0909 (SPIN)P.O..BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: --10-00000909
Property Address: _46686 -BRADSHAW TR
APN: 643-170-999-63 -31348
Application description: SPECIAL INSPECTION
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 100
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GLOBAL INVESTMENTS
3470 WILSHIRE BLVE
LOS ANGELES , �,�94
1101-1
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
#1020
3�1
0CT � E 20,0
o
Date: 9/15/10
Applicant: Architect or Engineer: FD CONSTRUCT ON I
73081 FRED W I LAQU1NTA
PALM DESERT, A 922QMjJA1!n_EDEPT.
(760)776-8300
Lic. No.: 814468
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of p ri ry at I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of t e Busin s and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens G License No.: 814468 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
!VA\ issued.
ate: ontracto • J have and will maintain work c mpensation insurance, as required by Section 3700 of the Labor
Code, for the performan oft a work for which this permit is issued. My workers' compensation
OWNER -B LDS ER DECLARATION insurance carrier and licy n mbar are:
I hereby affirm under penalty of perjury that I am exempt fro ntractor's State License Law for the Carrier GRANITE STATE Policy Number WC003 957781
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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1 1, 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.).
(_ 1 1, 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. , BAP.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 Name:
Lender's Address:
LQPERMIT
I certify [hat, in the per orma a of the work for which this permit is issued, I shall not employ any
person in any mann r so s to become subject to the workers' compensation laws of California,
and agree that, if I s ou become subject to the workers' compensation provisions of Section
/ -70Zofth Labor C I shall forthwith comply with those provisions.
at nt:
WARNING: FAILURE TO SECURE WORKERS' CO ON COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND Cl IL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITION TO THE COST OF CO PENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATT RNEY'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 su ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th the bove information is correct. I agree to comply with all
city and count dinances and state laws relating t bu- ing construction, and hereby authorize representatives
of
is co enter upo the above-mentione p o rty for inspection purposes.
Da " nature (Applicant or Agen
Application Number . . . 10-00000910
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit F.ee. . 100.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 100
Expiration Date . . 3/14/11
Qty Unit Charge Per
Extension
BASE FEE
100.00
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Special Notes and Comments
SPECIAL INSPECTION TO FINAL SFD.
ORIGINAL EXPIRED PERMIT # 06-1829.
LOT 65.
Fee summary Charged Paid
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Credited
----------
----------
Due
Permit Fee Total 100.00.
.00
.00
100.00
Plan Check Total .00
.00
.00
.00
Grand Total 100.00
.00
.00
100.00
}
LQPERMIT