13-0069 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
WENumber: 13-000000.69
Prope�trtdress: 56150 PGA BLVD
APN: 775 -370 -016 -
Application description: SPECIAL INSPECTION
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4950
d Q -!t 4 4 "
VOICE (760) 777-7012
FAX (760)777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/30/13
Owner:
KSL DESERT RESORTS INC
56140 PGA BLV
LA QUINTA, CA 92253
F,F,
Contractor: p I� J�;,,
Applicant: Architect or Engineer:
CLASSIC PARTY RENTALS
(CSLB LIC NOT REQ'D - GB)
75060 DR CITYOF'LAQu(NTA
•MAYFAIR'
PALM DESERT,: CA 92211 FIPIANCEDEPT•_____—
LICENSED CONTRACTOR'S DECLARATION
- 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 70001, 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: .license No.:
for'by Section 3700 of the Labor Code, for t*performance of the work for which this permit is
3
issued.
�/ 3� i
- Date:. Contractor: n
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
NER-BUILDER DECLARATION`
insurance carrier and policynumber are:,:. .
I hereby affirm under penalty of perjury that I am exemp6rom the. Contractor's State License Law for the
Carrier 3992 Policy Number- '
following reason (Sec. 7031:5, Business and Professions Code: Any city or county that requires permit to
_ I certify.that,'in the performance 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 applicant for the
person in any manner so'as.to become subjectto the workers' compensation laws of California,
permit to file signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and -agree that, if.1 should, become subject to the workers' compensation provisions of Section
•hall
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of thelabor e, I fo with�comp those provisions.-
.that he or she is exempt therefrom and the basis'for the alleged exemption. Any violation of Section 7031.5 by
an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
_
�lJy¢�w7ith
I 31 --3
ate: ✓ Xpplican
(_ 1 1, as owner of the property, ormy employees with wages as their sole conipensation,.will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and,ProfessionsCode: The
WARNING:. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License'Law does riot apply to an. owner of'propeity who builds or improves thereon, .
SUBJECT AN -EMPLOYER TO CRIMINAL PENALTIES AND .CIVIL FINES UP TO ONE HUNDRED THOUSAND
. and who does the work himself or herself through his or her; own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706.OF. THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
' oneyear 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and'Professions,dode: 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 contractors) 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
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
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'urider 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 permit, or cessation of work 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
this co']un)t to enter upon the above-mentioned prope. for i pection rposes.
Date: I ✓ (� VSignature (Applicant or Agent):
Application Number . . . . . 13-00000069
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit Fee . . . . 100.00 Plan Check
Fee
00
Issue Date . . . . Valuation
. . .
. 4950
Expiration Date 7/29/13
Qty Unit Charge Per
Extension
BASE FEE
100.00
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Special Notes and Comments
40 X100 "FAST TRACK" TENT STRUCTURE PER
ENGINEERED CALCULATIONS. 2010
CODES."WORLDWIDE GOLFSHOPS" ENGINEER:
HONOR M. ROBSUN C62694
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