04-6589 (RER)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION. REQUESTS (760)'777-71.53
BUILDING PERMIT
Application Number . . . . .. 04-00006589 Date 10./07/04
Property Address . . . . 78179 HACIENDA LA QUINTA
APN 646-280-014- - -
Application description REMODEL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 0
Owner 'Contractor,
STEVE:F:IGLIOLA RESORT CONSTRUCTION
2:046 HOLIDAY ROAD P:O. BOX 680.115
SALT LAKE CITY UT .84.117 -.PARK CITY UT. 84;068
(435) 658.-5051
WCC: W/G FvND
WC: / _g Z 74;0 0_3_/06 l_ e S
CSLB: 8.270,16 -1.1/3:0/05
CCC B
Other struct info .. . . . . CODE EDITION 2001
Permit BUILDING PERMIT
Addi.tional.desc
Permit Fee ., .00 Plan Check Fee .00
Issue; Date 10/07/04 Valuation, 0.
Expiration. Date 4/06/0,5
--------------------------------------------------------------------------------
Special Notes and Comments
SUPPLEMENTAL TO BUILDER'S SQUAR'E•RERMIT
0401-167 TO REFLECT CHANGE FROM OWNER
BUILDER TO NEW CONTRACTOR(RESORT
CONSTRUCTION)
i
Other Fees . . . . . . . . . CHANGE OF CONTRACTOR 4.50
Fee summary Charged Paid Credited Due ".
Permit Fee Total .00 . 0.0 `..00.:
Plan Check Total .00 .010 �.-00
Other Fee Total 4 , 5 0 A0 ` 00.
Grand Total 4.50 .00 ! 001, x-5'0
P.O. Box 1504 VOICE (760) 777,70..1.2
78-49.5 CALLE TAMPICO FAX (766) 177-7011
LA QUINTA, CALIFORNIA 92253' C I_NSPECTIO.NS (760) 777-7`153
BUILDING & SAFETY DEPARTMENT
Application Number: g�5 8 9 Date: 10 ' 7- a�-
Applicant: Architect or Engineer:
C 0 rt/'71',_'�C_21n
Applicant's Mailing Address: Architect or.Engineer'sAddress:
Lic:.No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
f hereby: affirm under penalty of perjury that l am licensed under provisions of Chapter 9 (commencing with:Section 7000) of Divisior.3 of the Business and Professionals
Code, and s L 7yx�ns fyc�,end effect.
License Class Cleanse No.
Date Q Contractor YJUW
OWNER BUILDER DECLARATION
1 herebyaffirn under penalty, of perjury that I am exempt from the Contractors' State Lioense Lawwforthe following reason(Sec. 7031.5; Business and Professions Code: Any
city,or county that requires a permit to construct; alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the,parnit to.file a signed
statement that he or sheJs licensed pursuant to the provisions of the Contractors' State Lioense,Law (Chapter 8.(commeacing with Section 7000) of:DiviionAof,the Business
and Professions Code) orthathe or. she is exemptdherefrom,and'the basis for. ".alleged exemptlon.. Any'violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of)notmore4hamfive hundred dollars ($500).):
U 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 or through -his or her own employees, provided that the improvements arenot 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.).
U 1, as owner of the property,, am exclusively contracting with licensed contractor 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 contractsJorthe projects with a contractors) licensed pursuant to
the Contractors' State License. Law,).
U I am exempt under.Sec. BA.PZ for thisreason
Date.
WORKERS' COMPENSATION'DECLARATION
,l; hereby,affirrn under penalty of perjury one of. the following declarations:
_ I have and will,maintain a certificate of consent,to self -insure for workers' compensation, as provided for bySection.3700 of the Labor Code, for the. performance
of the,work for which this permit is issued.
I have and wilrM intain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of thework for which this permit is
s tion jnsurance Carrier i
Carrier Policy Number
_ I certify that, in the performance, of the workfor which this part k rs issued, I shall -not employ any person in any manner so as to become subject'to the workers'
compensation laws of California, and agree that, if I should become,subjectto theworkers' compensation provisionsof Section 3700 of the Labor Code, I shall
forthwith comply,with,those provisions.
Date Applicant
WARNING: FAILURE.TO SECURE WORKERS' COMPENSATION"COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL.PENALTIESAND
CIVIL,FINES UP TO ONE HUNDRED'TWOUSAND DOLLARS'($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES ASPROVIDED FOR.IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penaltyofperjury that there Is a construction lending agency for the performance of -the work forwhich this pernit Is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT.Application, is hereby made to the Director, of Building and Safety;for a permit subject -4o the condlfions;and restrictions set.forth on this application:
1. Each person upon whose behalf thiaapplication is made,.each person:atwhose 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 workbeingperformed under or following issuance of this permit,
2. Any permit issued as a.resuftofdhis application becomes null and void if work.is not commenced wifhim180 days from date of issuance of such parnit,.or
cessation of work for :180 days will subject permit to cancellation.
l certifythat l haveread this,,appiication and state that theabove information in correct. 1 agree to cornply whh all city and county ordinances and state laws relating to building
construction, and hereby authorize,representatfves of this couptyA enter upon red rtyfor inspection purposes.
Date= Signature (Applicant or Agent):