05-3295 (RR)O. BMX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 .
Application Number: 05-00003295
Property Address: 49499 EISENHOWER DR
APN: 658-190-011-30 -28545
Application description: RE -ROOF
Property Zoning: TOURIST COMMERCIAL
Application valuation:. 750
Applicant:
T4hf
�VOICE 760 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
Architect or Engineer:
N) /,4
BUILDING PERMIT
Owner:
a LA QUINTA RESORTS
A 49=499 EISENHOWER DRIVE
D LA QUINTA, CA 92253
AUG 0 t 2005
CITY OF LA QUINTA Contractor:
FINANC_EDEPT. CARANO, RAYMOND
35688 CATHEDRAL CANYON DR #204
CATHEDRAL CITY, CA 92234
(760)333-3556
Lic. No.: 570657
----------------- --------------------------------
LICEN ED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of erjury that 16 licens nder provisions of Chapter 9 (commencing with
Section 000) of Division 3 of he Business ofe sion Is Code, and m License is in full force and effect.
License la : C33 C39 icenseNo.: 70657
,_---Date:% VOSontra r:
.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
anyapplicant 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.).
(_) 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.). -
(_) 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:
Lender's Address: '
WORKER'S COMPENSATION DECLARATION
Date: . 8/01/05
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 perfor ce o he work f which this permit is issued, I shall not employ any
person in any manner o as'to be a je to the workers' compensation laws of California,
and agree that, if I s uld becom ct to t e workers' compensatio provisions of Section
3700 of the Labor d I sh ith co ply with those provisio
ate: pplicant:
WARNIN - : FAILURE TO SECURE 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 thi ' anon becomes null and void if work is not commenced
within 180 days from date of ' ua--- of ch permit, or"cessation of work for 180 days will subject
. permit to cancellation.
I certify that I have read this applicatio and state that t abov info ation is correct. I agree to comply with all
city and c unty ordinances an state I ws relating t ing onstru ion, and hereby authorize representatives
of this o nt to enter u the abov m p fo inspection purposes.
'Gate: Signature (Applic n or
LQPERMIT
Application Number 05-00003295
'Permit . . RE -ROOF
Additional desc .
Permit Fee 30.00
Plan Check -Fee
..00
Issue..Date
Valuation . .
0
Expiration Date;. .1/28/.06
-
Qty ',UnitChargePer
Extension
BASE
FEE
30_00
Special .Notes and Comments
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'----
RE -ROOF WITH POLY URETHANE FOAM,
ROOMS
334-341.•
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
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