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09-1019 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA'QUINTA, CALIFORNIA 92253 Application Number: �- 0.0-07370,177,5 Property Address: 80875 PASEO DE ROSARIO APN: 766-110-016-54 -33597 Application description: SPECIAL INSPECTION Property Zoning: LOW DENSITY RESIDENTIAL Application' valuation: 100 c&tvl 4 4, 0", BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: R.T. HUGHES 78900 AVENUE 47, STE. 200 LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/22/09 Contractor: Applicant: Architect or Engineer: DANTOR MARTINEZ CONSTRUCTIO 81057 AVENIDA ROMERO D INDIO;• CPr:,92201 q Q (760.)702-6209 \IPC _ Lic. Nb.: 926128 �LP r7 �3.20`9.. l C! •LA ------------------ - - - - -- --------------------------------------------- - - - - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION•vtr'C hereby affirm under penalty of perjurynthatl 'm 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�pro "ded License Class: B L" erise No.:' 926128 for by. Section 3700 of the Labor Code,- for the performance of the work for which this permit is •r a issued. ate: �w �• tractor.• - .. _ 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 r O NER-BUILD D LARATION ' 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 EXEMPT Policy Number • EXEMPT following reason (Sec. 7031.5, Business and Professions Code: Any'city or county that requires a permit to certify that; intthe 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 subject to the workers' compensation laws'of California, permit to file a signed statement that he or she is licensed puisuanv o the provisions of the Contractor's State and agree that, if I' ul.d become s lbject :to the workers' compensation provisionsofSection License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the 6usiness'and Professions Code) or 3700 of the Labor o 6, 1 shall fort (wit provisions. that he or she is exempt therefrom and the basis for th'e alleged exemption. Any violation of Section 7031.5 by ( _ any applicant for a permit subjects the'applicant to a civibpenalty of not more than five hundred -dollars ($500).: e: ) - �. e__©9 icant: 1 1 1, as owner.of.the property, or my employees with wages as their sole compensation, will do the work, ander _ the structure is not intended or offeredfdr sale (Sec. 7044, Business and Professions Code: The • -WARNING:, FAILURE TO SECURE 'WORK RS' COMPENSATION " VE GE IS UNLAWFUL, AND SHALL - Contractors'�Siate License Law does not apply_to:an owner.of property who builds or improves thereon, 'SUBJECT.AN EMPLOYER TO CRIMINAL PENALTIES�AND CIVIL FIN P TO ONE HUNDRED THOUSAND and whodoes the work himself or herself through his ocher 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. one year of, completion, the owner -builder will have the burden of pioving that he or she did not build or ' improve for. the purpose of sale.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of'tKe property, am exclusively contracting, with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made�to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State•License Law does not apply to an owner of conditions and restrictions' set, forth on this application. property who builds of improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person tipon,whose behalf this application is made,`each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit,work is, performed under br pursuant to any permit issued as a result of this application, I_) I am exempt under Sec. , BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City 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 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 ilding construe 'on, and hereby authorize representatives of this county to enter upon the above-mentioned pr e y for inspecti n purer gnature (Applicant or Agent): Application Number . . . . . 09-00001019 Permit SPECIAL INSPECTION Additional desc . Permit Fee . . . . 100.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 100 Expiration Date . . 3/21/10 Qty Unit Charge Per Extension BASE FEE 100.00 ---------------------------------------------------------------------------- Special Notes and Comments SPECIAL INSPECTION TO COMPLETE CONSTRUCTION OF SFD. REFER TO PREVIOUS PERMIT # 07-1274. 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