08-1978 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001978
Property Address: 55955 PGA BLVD
APN: 775-220-003- - -
Application description: SPECIAL INSPECTION
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
. Td -Y440"
Applicant: lArchitect or ngineer:
\-7
SCOTT" i4S �4� C..
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PGA WEST
55955 PGA BLVD �j�--
LA QUINTA, CA 922531fo
Contractor:
Owner.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
COURSE
L-0 U
.DEC 312006
CITYOF LAQUINTA
Date: 12/30/08 .
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LICENSED CONTRACTOR'S DECLARATION
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WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that 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 the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate ofconsent to self -insure for 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 have and 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 issued•. My workers' compensation
- OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier - - - - - - - - - - - - - - - - - - - - - - -Policy Number
following reason (Sec. 7031.5, Business and Professions Code: 'Anycity'or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued;-( shall not employ 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 to the workers' compensation laws of California,
.permit to filen 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 7000) of Division 3 of the Business and Professions Code)•or
3700 of the Labor Code, I shall forthwith comply with those provisions.
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 I, 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 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. , BAP.0 for this r son
Date: Z 3 ! t7Pj Owner:
CONSTRUCTIONLENDINGAGENCY
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
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 ($100,0001. 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 rmit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a e infor ion is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin constr i n, an y authorize representatives
of this county t enter upon the above-mentioned property f ins cti rposes.
Date:'31 ignature (Applicant or Agent):
n
LQPERMrr
Application Number. . . . . . 08-00001978
Permit SPECIAL INSPECTION
Additional desc TEMP BLEACHERS FOR BHCC
Permit Fee . . . . 100.00 Plan Check
Fee ,.
.00
Issue Date . . . . Valuation
. . .
. 5000
Expiration Date 6/28/09
Qty Unit Charge Per
Extension
BASE FEE
100.00
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Special Notes and Comments.
SPECIAL INSPECTION TO TEMPORARY
BLEACHERS FOR THE 2009 BOB HOPE CHRYSLER.
CLASSIC GOLF TOURNAMENT.'APPROVED PLANS
SHALL BE"AVAILABLE `FOR INSPECTION. 2007
CODES..,TUP #2008-849.. INSTALLER.IS•T&B
EQUIPMENT, 11065 LEDBETTER RD. ASHLAND
VIRGINIA 2300.5. PH: 804-798'=2000.
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