05-3292 (RR)P.e~ BOX 1504
, 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003292
Property Address: 49499 EISENHOWER DR
APN: _�•. 658-190-011-30 -28545 -
Application description: RE -ROOF
Property Zoning: TOURIST COMMERCIAL
Application valuation: 750
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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D
Fuc o 1 zno5
Architect or Enginee
...Tv tZF lA
-LIC SEDCO TRACT DECLARATION /
I hereby affirm under penalty of perjury that am licensed n er rovi ions of Chapter 9 Icomme sing with
Section 7000) of Division 3 of the.Busines and.Profess de, a d my License is in full f ce and effect.
LicenseC ss: rCC33 C39 ns o.: 570657
ontr.-o,:
/ 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 ($500).:
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 1, 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:).
I—) 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 (Sec. 3097, Civ. C.). -
Lender's Name: -1
Lender's Address: N
"Roc Ks
3oq- 31-7
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/01/05
Owner:
LA QUINTA RESORTS
49-499 EI'SENHOWER DRIVE
LA QUINTA, CA 922.53
Contractor.
CARANO, RAYMOND
35688 CATHEDRAL CANYON DR 4204
CATHEDRAL CITY, CA 92234
(760)333-3556
Lic. No.: 570657
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
ILissued.
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 on
compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 22613
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manne beCct to the workers' compensation laws of California,
and agree that, if I ould beco_ the workers'compens ion provisions of Section3700 of the Labor de, I shmply with those pro sions.
ate: licant:
WARNINC. AILURE To SECURE WORKEll' 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 be null and void if work is not commenced
within 180 days from date of issuance of suc ermit, cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tha he above inf ma on is correct. I agree to comply with all
city and count ordinances and state laws relating t building cc st i n, and hereby authorize representatives
of this co ty o enter upon the above -mentioned o r i c pur oses. .
Date: Sign a (Applicant or Agent
LQPERMTT
Or
Application Number 05..00003292`
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
- 309-317.
:. 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
... LQPERMIT , • - .. - ..
-