04-3555 (SPIN)0�p
V s
BUILDING &.SAFETY DEPARTMENT
rc� P.O. Box 1504 (7.60) 7774012
tOF.ntti9 78-495 CALLE TAMPICo FAX(760).777-7011
LA'.Q:UINTA,'CA6f0RN.IA 92253INSPECTION REQUESTS (760)•777-7153
BUILDING PERMIT
Application Number X04=00-0"03555 Date 4/16/04
Property Address 50200 AVENIDA VISTA BONITA
APN : 6-5-8-2 6-0-9-9-9 - - f
Application.description .. SPECIAL INSPECTION
-Property Zoning NEIGHBORHOOD -COMMERCIAL -
Application valuation ,1500
Owner Contractor
CNL EOSPITALITY PROPERTIES INC BRUDVIK, INC.
450 S ORANGE AVE 600'EUGENE ROAD
ORLANDO FL 32822 PALM SPRINGS CA 9.2264 -
(760)320'74429.
WCC: .: ARCS 'INS
IO
WC.:... CYWW2 ,.02.65,. 03/:24/05
i. CSLB 4
8223 11/30./05
CC07
Permit : SPECIAL INSPECTION.:
Additional desc
-Permit Fee 100..00Plan. Check. Fee. ..00
Issue Date Valuation 1.500
Qty Unit. Charge Per.,.:, Extension
BASE,FEE 1;00.00
Special Notes::and Comments
SPECIAL INSPECTION OF GENERATORS..:
.PROVIDING TEMP POWER FOR EVENT
Fee summary Charged Paid Credited Due'`
Permit Fee.'Total 100:00 .00 .00 :100..00:
Plan .Check Total .0-0... 00
Grand Total 100'G00; 00'.. .00 100:00
P.O. Box 1504 a �/
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 FAX
(760) 777-7153
Application Number.
Applicant:
Applicant's Mailing
BUILDING & SAFETY DEPARTMENT
Date: 4f- 16-014
Architect or Engineer.
Architect or Engineer's Address:
fV ��
Uc. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter a (commencing with Section 7000) of Division 3 of the Business and'Professionals
C Class_ my licerae is to fullme tomrd effect
. see
No.y 23
0
C- -
that 1 am
hereby affirm under penalty or perjury OWNER -BUILDER DECLARATION
exempt tram the Contractors' State License Law for the following reason (Sea 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 permit b tie a signed
statement that he or she is licensed pursuant to the provisions of the CM08CWW State License Law (Chapter a (comrencng with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom ond'the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not mire than five hundred dollars ($500).):
U I. as owner of the property. or my employees with wages as thek sole compensatim-will do the work, and the stru cWm is not intended or offered for sale (Sec. 7044.
Business and Professions Code: The Contractors' State License Law does not apply b 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 irnprovements are not intended or offered for -sale. K, howeyer. the buidahg or improvement is
sold within one year of completion, the owner4xMder will have the burden or proving that he or she did not build or Improve tror the purpose of sale.).
C-) i. as owner of the property, am exclusively contracting with licensed contractors to Constnut the project (Sec. 7044. Business and Profession Code: The Contractors'
State License Law does not appy b an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) ficerned pursuant to
the Contractors' State License Law.).
U 1 am exempt under sec. . BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4nsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance
of the walk for whidh this permit is Issued.
1 have and will maintain wakens' compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is
_ My compensation insurance carrier andnumber are:
rrie< -- )60 Number ' YLA) 0 -Jr- Co a h.
_ 1 that, lh the peAormance of the wok for which this permit is issued. l chap not employ any personrnany manner so as to become subject to the workers'
compensation taws of California, and agree that if 1 should become subject b tlme workers' cortmpensatian provisions of Section 3700 of the Labor Code. I snap
forthwith WnVty with those proA*M.
U
WARNING: FAILURE TO SECURE WORKERS' GtOMBEkUTI& COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES uP TO ONE HUNDRED THOUS/Wp DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm ander 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.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for 8 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 los performed under or pursuant to any permit
issued as a result of this application. the owner, and the applicant, each agrees to, and shhatl, defend, indemnify and hold hardess the City of Le Outnta, its
officers. agents and employees for any ad or omission related to the work being performed under or following issuance of this permit
2 Any permitt Issued as a result of this application becomes null and void I work is not commenced within 140 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 carred I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes.
ate �4 Signature (Applicant or /gent):
up- m
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