05-3299 (RR)36,60 - 3773
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
. FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: 05-00003.29.9 Owner:
Property Address: 49499 ISENHOWER DR LA QUINTA RESORTS
APN: 658-190-011-30 -28545 - 49-499 EISENHOWER DRIVE -
Application description: RE -ROOF LA QUINTA,..CA 92253
Property Zoning: TOURIST COMMERCIAL
Application valuation: 750.
D(� Contractor:
Applicant: Architect or Enginee CARANO, RAYMOND .
AUG O 2005 35688 CATHEDRAL CANYON DR #204
CATHEDRAL CITY, CA 92234
CITY OF LA QUINTA (760)333-3556
f'l FINANCE DEPT. LiC. No.: 570657-
CENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pe ry tha 1 am li n d under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of th .Busines n P fes ovals Code, and my License•is in full force and effect.
License �lassi C33 C39 � License No.: 57_"f 57
/bate: Contractol:
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 she is,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 15500).:
(_ 1 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 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 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.l.
I—) 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:
Date: 8/01/05
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
14issued.
, haveand 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 STATE FUND ' y Number 22613
I certify that, in the perfor nce of the ork for which this permit is issued, I s all not employ any
person in any manne so as to bec a subject workers' compensatio laws of California,
and agree that, if I ould becom subje to t e wor rs' compensation pr isions of Section
Q3700 of the Labor forth i co ply with those provisions.
ate: t(J cant:
WARNING. FAILURE TO SECURE WORKERSI COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 applic es null and void if work is not commenced
within 180 days from date of issuanc f such per t, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and s to that the above of rmatio is corr ct. I agree to comply with all
city and ou y ordinances and state laws re ting to building n r ion and her y authorize representatives.
of this c unt t nter upon the above-ment ned in n urpose
Oate: ignature (Applicant or gen
LQPERMIT
Application Number 05-00003299
Permit . . RE -ROOF
Additional desc ..
Permit Fee 30.00
Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date .1/28/06
Qty Unit Charge Per
Extension
BASE
FEE
30.00'
Special Notes and Comments
RE. -ROOF WITH POLY URETHANE FOAM,
ROOMS
366-373.-
Fee summary Charged
Paid Credited
Due
Permit Fee Total 30'.00
.00
.00
30.00
Plan Check Total .00
:00
.00
.00
Grand Total 30.00
.00
00
30.00
J