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09-1021 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: CO 2� Property Address:. 80855 PASEO DE ROSARIO APN: 766-110-016-56 -33597 - Application description: SPECIAL INSPECTION Property: Zoning: LOW DENSITY RESIDENTIAL Application valuation: 100 Ta�/ 4 4 Q�", BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: R.T. HUGHES 78900 AVENUE LA QUINTA, CA 47, STE 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/22/09 Contractor: ,D Applicant: Architect or Engineer: DANTOR MARTINEZ CONSTRUCT C<ji,?��/•� 81057 AVENIDA ROMERO/,•� ��' �/�7 f�� INDIO, CA 92201 (760) 702-6209 �1P LiC. No.: 92.6128 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm -under penalty 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 -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 Licen lass: B - Li ense'No.: .926128 .. for by Section 3700 of the Labor Code, for the performance of the work for which this permit is p _�w�] issued. .Date:'('L2'�'1 tractor '. j _ _ 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-BUILDERJDE- RATION- _ insurance carrier and policy number are: I herebyaffirm under penalty sof perjury that Fam exempt from the onfractor,s State License Law for the Carrier XEMPT .,Policy Number EXEMPT following reason (Sec: 7031.5, Business.and Professions Code: Any city or county: that requires a.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 repaivany structure, prior to its issuance; also requires the applicant for the personin 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 pursuant to the provisions of the Contractor's State and agree that, if,l 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 th Labor e, 1 shall to hwith comply with those provisions. that he or she is exempt therefrom and the basis for the.allegedexemption.. 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 MOO).: ate. -6. pplicant: (_ 1 1, 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'oif&ed for sale.ISec. 7044, Business and Professions Code:' The WARNING: F URE TO SECURE WORKERS' COMPENSATIO AGE IS UNLAWFUL, AND SHALL Contractors' State.License Law does not apply to an -owner of property who, builds. or improves thereon, SUBJECT -AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 'FINES UP TO ONE HUNDRED THOUSAND and who' do- the ovork himself or herself.through his or her own employees, provided ffiaTthe DOLLARS 15100,0001. IN ADDITION TOTHE 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 proving that he or she did not build or - . improve for the purpose of sale.).' - - APPLICANT ACKNOWLEDGEMENT 1 _ 1 1, as owner of the 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. propertywho builds or improves thereon, and who contracts for the projects with acontractor(s) licensed 1 . Each person upon whose behalf this. application is made, each person at whose request and for pursuant to theContractors' State License Law.)• whose benefit work is performed under or pursuanttoany permit issued as a result of 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 county to enter upon the above-mentioned prop e y or inspe tion purp9 es. Lender's Name: Dat C Da Si lure (Applicant or Agent): eql Lender's Address: Z LQPERMIT 4 Application Number . . . . . 09-00001021 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 7.SFD' ` REFER TO'"PREVIOUS" . PERMIT_.#. -;-07-1276 . Fee- summary.. • Charged Paid ' Credited Due Permit''Fee.Tota1 100:00 .00 .00 100.00 Plan Total 00_ .00.. Q0 :00 --Check Grande Total 100.00 .00 00 10.0..0.0 Al LQPERMIT