05-2917 (SPIN)r.0...EOX 1504
78-495 CALLE TAn
LA QUINTA, CALI
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Appiication Valuation:
Applicant:
9244- 18 2005
81150 SANTA ROSA CT
764-270-999-D -300234-
SPECIAL INSPECTION
MEDIUM HIGH DENSITY RES
50000
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
'BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
CLASSIC PA_RTY'RENTALS
(CSLB LIC NOT REQ'D - GB)
75060 MAYFAIR 'DR
PALM DESERT, CA 92211
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 7/18/05
------ ----- ------ -------------_=-------------'=--------- ----------------------------—
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
herebyaffirm,undecpenalty of perjury that l 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'theBusiness and ProfessionalsCoAe, and Licenseisin fulhforce and effect. _ I have and will maintain acertificate of consent to self
License
workers' compensation, as provided
License Class: - License=No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. ,
Date: Contractor: i _ I have,antl.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`issu'iied'. i Ay workers' compensation
OWNER -BUILDER DECLARATION insurance carrierand policy,numbevare: '
hereby affirm underper alty of perjury.that.I am•exempt from the Contractor's State License Law,for the Carrier 3992. 'Policy Number
following reason,(Sec. 703 f.5, Business and Professions Code: Any city or. county that requires a permit to _ I certify that; in the perfoimance of the work for which this permit is issued, I shall not employ any
construct;. alter, improve,.demolish, or repair any structure prior to its issuance, also requires the appfcant,for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to�file a'signed statement that heorshe is licerised pursuanttothe provisions of the Contractor's State and.agree that,,if I should become subject.to the workers' compensation provisions of Section
Li6ense1aw (Chapter 9 (commencing with Se,ction'7000) of Division 3 of,theBa siness and Professions Code) or 3700 of the Labor Code, I shall forthwith. comply with those provisions:
.that heor she is exempt therefrom andthe basis for the alleged. exemption. `Any violation of Section 7031.5'by
any applicant'fora.permit subjects the'applicant to a civil penalty of not'more than five hundred dollars ($500).:
( 1 I, as.ownerof.the property, or my employees ;with.wages.as theiusole compensation,.will do the work, and
^-the structure is not. intendedrorl dAr'offesale=(Sec. 7044; Business and Profm.ions Code: The'
Contractors' State License Law Roes-notapply,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 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
1 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
Date: Applicant:
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). IWADDITION 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'Direcior'of Building'and-Safety fora -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 orpursuant 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) have read thisapplicationand 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
Dto�enter
�upon the above-mentioned property for inspection urposesct/ 1�kuetd.
,Kte: Q (/" ature (Applicant or Agent):
Application Number . . . . . 05-00002917
Permit . . . SPECIAL INSPECTION
Additional desc..
Permit Fee . . . . 100.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 50000
Expiration Date 1/14/06
Qty Unit Charge Per Extension
BASE FEE 100.00
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Special Notes and Comments
SPECIAL INSPECTION FOR 40' X 80' SHADE
STRUCTURE FOR EVENT TO BE HELD ON
7/19/05, PER TUP # 2005-557. VERBAL FIRE
DEPARTMENT APPROVAL RCVD. 7/118/05
(NEIL STEPHENSON)
Fee summary Charged Paid 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