11-0829 (DEMO)I - .M11111,
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- 00 0082.9
KV
8075SAO-AT, RT
7.75 -220 -'020 -
DEMO - COMML/OTHER
GOLF COURSE
500•
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MSR RESORT GOLF COURSE
1 POST OFFICE SQ #3100
C/O PYRAMID
BOSTON; MA 02109
Contractor,:,
JACOBSSON ENGINEERING
P.O..BOX 14430
PALM DESERT, CA 92255
(760)345-8700
Lic. No.: 650389
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/27/11
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2 / nr� f.
•.:�I 20.11.
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' LICENSED.CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby.affirm under penalty of.peijury that I am licensed under. provisions of Chapter 9 (cornmencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business 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 -
License Class:` A -B - - ' •License No:: 6503'89,
. for by Section 3700.of the Labor Code, for the performance of the work for which this permit is
/-ontractorr..�•JNd-aa>:On/�i'E�6�/iTiv -
issued. _
ti have and:_will maintain -workers' compensation insurance, as required by.Section-3700; of the Labor
Code,' forthe'performance of the work for which this permit is issued-. My workers' compensation
' .OWNER=BUILDER -.DECLARATION •
insurance carrier and policy numb erare: �-
1 hereby affirm under penalty.of perjury that.l am exempt frohem tContractor's. State. License Law for.the
Carrier BENCHMARK- Policy Number CSTS001063 - -
following reason (Sec. 7031,.5, -Business and. Professions Code: .Any city orcounty.that requires a permit -to_
I,certify,that, in the performance of the :work ,for which this permit is.issued, I shall,novemploy any
construct, alter,'improve,"demolish; or repair any structure, -prior to its issuance,`also requires the -applicant for the
' Person in any manner: so as to become subject fo the workers' compensation laws -of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I should. become subject to the workers' compensation provisions of Section
License.Law (Chapter:9'(commencing with. Section 70dO).of Division 3 of theBusiness and Professions Code) or
"'3700of the Labor Code, I shall forthwith comply with those provisions. `
That he,or she is exempt therefrom and the (iasis for the alleged exemption Anyvrolation of Section 7031°5by
p/��//�
any applicant for a permit subjects the applicant to a civibpenalty of, not more tiier . five hundred dollars ($500).:
�
ate: 1 JA pficant:-
( - ) I,� as oviner'of the property; or my;employees:with wages, as their sole.,compensation, will do the work, and
/
not intended or off, ed for sate (Sec. 7044, Business and Professions Code: The _
WARNING- FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLAWF,UL,.AND,;SHALL
_-the•sNucture-is
- Contractors'. State Licehse'Law does"not apply,to an owner of property who builds or improves thereon,
SUBJECT AN.EMP.LO.YER.TO:CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE•HUNDRED. THOUSAND '
and°who does the work,himself;or tierself through his or her own employees provided,thatthe-
DOLLARS ($100;000). IN ADDITION;.TO THE COST OF COMPENSATION;'DAMAGES AS PROVIDED-FOR.IN
improvements are:.notintended:or'offered for sale.. It; however the building or. iio rovementtis sold within
SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S -FEES.. -
.
. one,yearof-completion, .the'owner-builderwill have'the.burden otproving that he: or she did not build or
•APPLICANT
improve for the•purpose of sale'.).. _ -
ACKNOWLEDGEMENT . .
1 _) I, as owner of:the.!property; am exclusivelycontracting with licensed contractors to construct the project (Sec.
'IMPORTANT Application is;herebymade,to the Director of Building and Safety fora'permit subject to the
7044, Businessland Professions Code: The Contractors' State License Law does not apply to an owner of
" conditions andrestrictions set forth on this application. -
property who.builds'or improves thereon, and who contracts for the projects with -a contractors) licensed
1 . Each person upon: whose behalf this application is made, each person aLwhose request and for
pursuant-to.the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a'resultof this application,
(_) I am exempt under Sec.B.&P.C. for this reason
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. '
Date: Owner:
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
' CONSTRUCTION LENDING AGENCY ..
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this'application and state that the -above information is correct. I agree to comply with all
" work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this ounty to enter upon the above-mentioned proper[ fXinction purposes.
Lender's Name:
-7/1
I Si attire (Applicant or Agent)••
Lender's Address:
LQPERMIT
LQPERMIT
Application Number . . . . 11-00000829
Permit DEMO PERMIT
Additional desc .
Permit Fee . . . 45.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
500
Expiration Date 3/25/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
-
-------------------------------------------------------
Special Notes and Comments
-------
-------------
•DEMOL'I.TION:OF EXISTING NON COMPLIANT
�.-
... : r::TRAILER=�rAND ATTACHED=,STRUCTURES;:::-• ...-.-.
.
_
LOCATION. OF TRAILER IS .ON -GOLF ;COURSE IN,
THE PROXIMITY"OF''55-'487 SOUTHERNsHILLS
a:.GOLF. CART .PATH.
nti
:F.ee summary... Charged. Paid, Credited
Due
Permit Fee Total 451.00; 00
.0.0
45:00
Plai-Check, Total .0'0 :00
00
00
s`.
Grand Tdtal. 45,:,00 00
00
45.00
LQPERMIT
Bin #
Get. ,of La- Quinta
Building 8t Safety Division
P.O. Box 1504i.:78-495 Calle Tampico
La Quinta, CA 92253 -,(760) 777-7012
Building Permit Application -and. Tracking Sheet
Permit #
Project Address: 60,—US O k Aoj,�"
Owner's Name: Q�Rl�� •: � ��£�
A. P. Number: 7 6-. 2'2-0— 0Z'0
Address: SO- lob A1elt�Axq� VZ:5-M 0vrT-Y)
Legal Description:
City, ST, Zip;[/ 19 tZ/ CA 22 3
Contractor:C c-
A��JC7/I� � / �✓�r�Jl✓
;Telephones 1(,-0-177- -5-2'01
Address: "00 g ox ' LIL13 -6
, ProjebVDescription: -Furs �'4M_x r Ws4 (_,
.
City, ST, Zip: 0AL/n &J47
�
96-FOf, TIC ��otrTILOA/ OF
�S�
0Tele hone: 7�7a
3
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U P �
a�✓ Eb z� .r ��
G N
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State Lic. #: 6 sO J_n i'
'.CityLic. #..' 3.P..2}6:•::::,
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:
vf:
..onstruction T e:
yp Occupancy:
State L ic. #
y.: •
Project•type (circle one): New Add, n Alter Repair Demo
Name of Contact Person: Ar 16UjQNAir,
Sq. Ft. 33 %
# Stories:
#Units: '
Telephone # of Contact Person: W 0- % 7S` E •� 1
Estimated Value of Project:
• r ,
APPLICANT: DO, NOT:WRITE'BELOW THIS LINE,
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called ContactTerson
Plan Check Balance
Tide 24 Calcs.
Plans;picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2". Review, ready for. corrections/issue
Electrical
Subcontactor List
Called Contact -Person
Plumbing
Grant Deed
Plans picked up..
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
INHOUSE:-
'"'Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
.Total Permit Fees