05-5140 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA. 92253.
:Application, Number: 05 - 00005;140
Property Address: 50.68'Q EISENHOWER DR
APN: 773-170-029- -
Application description: SPECIAL 'INSPECTION
Property Zoning: MEDIUM DENSITY RES
Application, valuation: 2150_.0
BUILDING &: SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
APTS®.,LQ.VILLAGE LP
1105'QUAIL ST.
NEWPORT'BEACH, CA 92660
Contractor:
.Applicant: Architect or Engineer:: MARK COMPANY:
228'8, ,BATAV.IA
ORANGE, CA 92865
J.r1, ('714) 685-2462
Lid., No.: 266187
LICENSEDCONITRACTO R'S' DECLARATI ON'
I hereby_affjrm under penalty of perjury'that.l am licensed:under provisions of.Chaptar;9 (commencing with
Section 7000).of Division 3 of the Businese;and'ProfIessionels Code„and my License is in fulhforce and effect.
License'.clsss: A ElLicense No:: 266187
/;, _ :actor:. -
;OWNER -BUILDER DECLARATION
I hereby under penalty of perjury that.(am exempt from'the Contractor's;State License Law for the
fdlowI a reason (Sec. 7031.8, 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
permit to file a signed staterrient,thathe or she is,licensed pursuam to the.prowsions,of the Contractor's State:
License Law; (Chapter 9 (commencing with Section 700%otDivision 3 of the'Businew and;Professions Code) or
'that;he or she'is exempt therefrom,and the basis for the alleged exemption.- Any violation of Section 7031.6 by
any applicant for a permif:subjects the applicant to a civifpenalty of,not;more;then five hundred dollars (8500).:
(_ ). I, as ownerof the property, or1mv employees: with'wages as their sole compensation, will;do the work, and
the,structure la;not-intended or offered for "WISeo: 7044; Business a1. .Professions Code: The
Contractors' State License Lew does'not apply,wanowner,of propertywho 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'oroffered for sale. If, however, the. building, or'improvement.is sold'Within
one yearof completion the owner -builder -will have the burden of proving that'he or she did not build or
improvelor the purpose of sale:(.
�) I, as owner' of the property, am exclusively contractin licensed contractors to construct the,proiect.(Sec.
7044, Business and Professions; 9: Ttie Co - act s' State'License Law does notepply to en'owner-of
Property who builds or improves thereon; a ho ntracts:fort/�r�J}eets with a contractors) licensed
pursuaiit.to the Contractors' State Licensew.
(_ ► I am exempt Sec. B.& C. f t reason y
Dttei Owner06L Ll -k
CONSTRUCTIOWLENDING AGENCY
I hereby affirm under penalty of;peoury that there Is a construction.lending agency for the performance of the
work for which this permit is Issued ISec; .3097, Civ. C:):
Lender's Name:
Lender's Address:
LIQPE R IIT.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/23/05
,` )v 2 3 2005
PINAHICE
WORKER'S COMPENSATION DECLARATION
I h_ ereby.effirrn under penaky,of perjury one of the following declarations:
_ I have and wrll,maimain a certificate of consentto self -insure -for workers' compensation, as provided
for by Section 3700 of the,Labor Code, 1or,tfte performance of the work for which,ths,petmk is,
issued.
_ I.have and will maintain workers' oompensadominsuranoe as required by:Sectiom3700 of the Labor
Code, for the performance otthe workEforwhich this permit;is',issued. My workers' compensation
insurance carrier and policy number,a-re'
Carrier- STATE: FUND Pol'icyNumber 046=0010738
I;certifythat; in'the performance of the.work1orwhich this permit -is issued, I,shall'not employ any
person in any manner so as to a subject to the workers' compensation laws of California,
and spree that; if I should bacontijecttq the workgr_ Ncompensation:provisions of Section
WARNING: FAILURE TO SECURE WORKERS''COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO'CRIMINAL.PENALTIES AND'CIVIL FINES UP TO ONE HUNDRED?HOUSAND
DOLLARS (8100;ODO).:'IN ADDITION TO THE COST OFCOMPENSATIONj DAMAGES AS PROVIDEDFOR IN
SECTION: 3708' OF THE LABOR CODEi. INITEREST,. AND ATTORNEY'S FEES:
APPLICANT' ACKNOWLEDGMENT
IMPORTANT Application'is hereby made,to the Director of Building and Safety for a permitsubject to the
conditions and restrictions `astforth on,this application.
1: Each ,person,upon whose behalf thisapplication(s made,each person at whose.request and for
whose benefit work is.performed'under or pursuant to any permitJssued as a result of this application„
the owner, and the applicant; each agreesto, and shell defend jndemnifyand'hold'harmlass the City
of La;Quirrta its officerej agents and,employees'for,_ any act or omission related to the work being
performed under or following Issuance of this Parton.
2. Any permit issued as a resultof this application becomes: I and voidrf work Is not commenced
Within 180 drys, from data of issuance of. such permit,: 'on of work for 180 days willsWb_ jest
permit to;cancellation.
I certify that I have'read this application and state that above i mation is, la to complywith all
city end county ordinances and pffW,IaWs releting'to buil ing c ion,'and. yaut n 'mpresbntatiyas
�/ cognty t"kn _ above-mentioned props, for i ion pu s
Date(, Z �J gnature (Applicant or Agent)'
14
LOPERMr
Application Number . . . 05=00005140
Permit SPECIAL INSPECTION
Additional dere,.
Permi't'Fee 100.00 Plan Check.Fee
:00
Issue Date . . . Valuation
21500
Expiration Date 5/22/06
Unit. Char a Per
Exten-
1oa--jn
---------:Qty-- ----g-------_BASE-FEE--------------------------
Special Notes and Comments
---
SPECIAL INSPECTION OF SHELL :IN ORDER.'TO
POUR -NON-STRUCTURAL SLAB IN PREPARATION
FOR TI &EXTENSION OF UNDERGROUND
PLUMBING ABOVE FINISH GRADE
Fee summary Charged Paid Credited.
Due
Permit Fee .Total 100.00 .0.0 .00
100.00
Plan Check .Total .06 :00 .00
:0'0
Grand Total 10`0..00. .00. .-00
100:.00