10-0945 (RC)tit
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO - 4 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING-& SAFETY DEPARTMENT' INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/20/10
Application Number: c=j-10�00000945Z�> Owner:
Property Address: 49499 EISENHOWER DR DESERT RESORT
APN: 658-190-011-30 -28545 - C/O CNL HOSPITALITY PROP INC
Application description: REMODEL - COMMERCIAL 450 S ORANGE AVE #12TH I�(11 A i
Property Zoning: TOURIST COMMERCIAL ORLANDO, FL 32801 UI fl
Application valuation: 63492 � T- q
Contractor: ` C j 2 0 20I0
i
Applicant: Architect or Engineer: � OLSON CONSTRUCTION LP, RD 1
2955 MAIN STREET - THIRD ILOOR CITY OF! -A QUINTA
IRVINE, CA 92614 P - {}E7PT.
(949) 474-2001
Lic. No.: 580097
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: 13 1cense No.: 580097
eE ate: � ntractor: � C S d
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law, for the
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
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State '-
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or sheds exempt therefrom and 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 more than five hundred dollars ($500).:
(_ 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 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 through his or her own employees, provided that the
improvements are not 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.). %
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). - - -
( 1 I am exempt under Sec. , BAP.C. for this reason
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:
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WORKER'S COMPENSATION DECLARATION
I hereby affirm 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 by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
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
insurance carrier and policy number are:
Carrier ZURICH AMERICAN Policy Number WC368668703
_ I certify that, in the performance of the work for which this permit is 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 subject to the workers' compensation provisions of Section
3700 of the Labor CoihsJ4hall
forth%' h comply with those provisions.
ate: D 0 pplicant: • '
WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a 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 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 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 building construction, and hereby authorize representatives
.of this county to enter upon the above -mentioned property fdfl spection purposes.
r c
15ate� ignature (Applicant or Agent):
LQPERMIT
Application Number . . . . 10-00000945
------ Structure Information EXISTING.R-1 BLDG
-----
Other struct info CODE EDITION'
2007/08
MIXED -USE OCCUPANCY
R-1
OCCUPANT LOAD-
.00
1ST FLOOR SQUARE FOOTAGE
.00
2ND FLOOR SQUARE FOOTAGE
.00
Permit . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 477.50 Plan Check Fee
77.59
Issue Date. Valuation . .
. . 63492
Expiration Date 3/19/11
Qty Unit Charge Per
Extension
BASE FEE
414.50
14.00 4.5000 THOU BLDG 50,001-100,-000
63.00
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Special Notes and Comments
P
UNITS 852,853 REPLACE EXTERIOR.TILED
DECKING ON SECOND FLOOR (INCL.
SHEATHING). REPAIR WATER DAMAGE -IN UNITS
BELOW #857,854. ADD DRAFT STOP AT
FIREPLACES AND UNIT SEPARATION WALLS.'ADD
R-30 INSULATION CEILING INSULATION ABOVE
GROUND FLOOR UNITS.2007 CODES, 2008
ENERGY.
-----------=-----_-_--------------------------------------------------------
Other Fees BLDG STDS'ADMIN (SB1473)
3.00
Fee summary Charged Paid Credited
---------
Due.
----------------- ---------- ----------
Permit Fee Total 477.50. .00 .00
477.50
Plan Check Total 77.59 .00 .00
. 77.59
Other Fee Total 3.00 .00 .00
3.00
Grand Total 558.09 00 .00
558.09.
LQPERMIT • 1 -