05-3291 (RR)>
P.Att X%1.504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003291
Property Address: 49499 EISENHOWER DR
APN: 6.58-190-011-30 -28545
Application description: RE -ROOF
Property Zoning: TOURIST COMMERCIAL
Application valuation: 750
1&4 . 44Q &M
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LA QUINTA RESORTS.
e 49-499 EISENHOWER DRIVE
DLA QUINTA, CA 92253
I pUG 0 1 2005
VOICE (760) 777-7012
'FAX (760) 777-7011
INSPECTIONS (760) 777-7153
®U!PlTA Contractor:
,Applicant: Architect or Engineer CIPY ®� CARANO, - RAYMOND.
FINANCE DEPT 35688 CATHEDRAL CANYON DR # 2 0 4
CATHEDRAL CITY, CA 92234
.n (760)333-3556
Lic. No.: 570657
PMSEW NTRACTOR'S DECLARATION
I hereby affirm under penalt"of perjury. t I am license• 11 provisions of Chapter 9 (commencing with
Section 009) of Division 3 of the Bu ess and "ofes als C e, and my Licenser"s-in full force and effect.
License dIas9: C33 C39 Lice se No.: 570-687
Contractor:
t OWNER -BUILDER DECLARATION
I hereby a irm 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 ($500).: '
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.). -
1 _ 1 I am exempt under Sec. , B.&P.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 ISec. 3097, Civ. C.).
Lender's Name: ' l
Lender's Address: 1�
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 .
issued. '
1_1 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 STATE FUND Policy Number 22613
I certify that, in the performan a work for which this permit is issued, I shall not employ any
person in any mann4uld
4ee
su ' jto the workers' c 'mpensation laws of California,
and agree that, if I tothe workers' com nsation provisions of Section
3700 of the bori h comply with those ovisions.
$ate: plicant:
WARNIN FAILURE TO SECURE WORKERS' tOMPENSATION 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 applicat ec es null and void if work is not commenced
within 180 days from date of issuance such permi or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and st a that the a ove ' for ation i correct. I agree to comply with all
city and county ordinances and state laws rel i to buildin c stru tion, and hereby authorize representatives
of thiqunto er upon the above-menti n pe ion purposes.
)Ddte:nature (Applicant or nt):
LQPERMIT
Application Number 05-00003291
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
301-308.
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
36.00