07-0100 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application,Number: 07=00000100;
Property Address:_ 4 77750 AVENUE 50
APN: 658-1907003- - -
Application description: SPECIAL INSPECTION
Property Zoning: GOLF COURSE
Application valuation: 0
Applicant: ' Architect or Engineer:
392i2
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
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 signedstatementthat 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 orimproves 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 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 contractors) licensed
pursuant to the Contractors' State License Law.). -
( 1 1 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: a _
Lender's Address: _
.VOICE (760) 777-7012
FAX'(760) 777-701,1 ,,
INSPECTIONS (760) 777-7153
Date: 1/11/07 IN
Owner:
BOB HOPE CHRYSLER CLASSIC
39000 BOB HOPE DRIVE
RANCHO MIRAGE,.CA 92270
---------------------------------
Contractor:
Owner
-----=-_--- ----- D ----Q
JAN 26 2007.
_ _ _ _ CITY OF LA QUINTA
• — — - — - — — — — — — — — — - WORKER'S COMPENSATION^DEe
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 Policy Number
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 Code, I shall forthwith comply, with those provisions.
Date: Applicant:
WARNING: 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 ($1.00,000). 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 fora 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 omissi related to the work being
performed under or following issuance of this p mit. -
2. Any permit issued as a result of this application ecomes null and id if work is not commenced
within 180 days from date of issuance of suc permit, or ces on of work for 180 days will subject
permit to cancellation. -
I certify that I have read this application and state that the ove infor on is correct. I agree to comply with all
city and county ordinances and state laws relating to buil constr' n, and hereby authorize representatives
of this county to enter upon the above -mentioned proper r insp on purpose
Date: T7 q lature (Applicant or Agent)' '
f
LQPERMIT
e-
Application Number 07-00000100
Permit . . . SPECIAL INSPECTION
Additional desc BLEACHERS FOR THE BHCC
Permit Fee 100.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 7/10/07
Qty Unit Charge Per
Extension
BASE FEE
100".00
----------------------------------------------------------------------------
Special Notes and Comments
BLEACHERS AT LA"QUINTA COUNTRY CLUB FOR
THE 2007 BOB HOPE CHRYSLER CLASSIC
TOURNAMENT. 2001 CBC.
Fee. summary Charged Paid Credited'
----------
Due
-----------------------------------------------
.Permit Fee Total 100.00 .00
.00
100.00
Plan Check Total .00 .00
00
.00
Grand Total 100.00 .00
.00
100.00
LQPM11T