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10-0749 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&t!t 4 4 Q" Application Number: 10-00000749 Property Address: 45280. SEELEY DR APN: 604-630-025- - - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: TOURIST COMMERCIAL Application valuation: 30000 Applicant: - Architect or Engineer: 91A BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: EISENHOWER MEDICAL CENTER 39000 BOB HOPE DR RANCHO MIRAGE, CA 92270 Contractor: WDL CONSTRUCTION 74075 EL PASEO, SUITE B3 PALM DESERT, CA 92260 (760)674-9553 LiC. No.: 741137 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/19/10 AUG 2 4 2010 ____ ----------------- LICENSED CONTRACTOR'S DECLARATION _____---—-—--——---------——--—-------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business an rote Is Code, antl my License is in full farce and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: I License No.: 741137 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Date: issued. —O&Mfocontracton _ I have and will maintain workerscompensation 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's Stare License Law for the Carrier DELOS INS Policy Number 0IDKRM12007667 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions f the Contractor's State and agree that, if I should become sub ct to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Snameas and Professions Code) or 3700 of the Labor Code, Ito Mith comply with those provisions. 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 (5500).: &ate: Applicant (_) 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 WARNING: FAILURE TO SECU E W RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 comedians) licensed pursuant to the Contractors' State License Law.). (_ I I am exempt under Sec. , B.&P.C. for this reason Data: 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: LQ1'E T 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 Quints, 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 becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building /dnwuctio , and hereby authorize representatives of this county to enter upon the above-mentionetl proper[ f reps i purposes. Date: 0MOSignature (Applicant or Agent)_ Application Number . . . . . 10-00000749 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 284.50 Plan Check Fee 184.93 Issue Date Valuation . . . . 30000 Expiration Date . . 2/15/11 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 ------------------`------------------------------------------- THOU BLDG 25,001-50,000 32.50 Permit . . . ELEC-MISCELLANEOUS Additional desc . . Permit Fee . . . . 30.00 Plan Check Fee 7-.50 Issue Date . . . Valuation . . . . 0 Expiration Date . . 2/15/11 Qty Unit Charge Per. Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 ----------------------------------------------------------- _________________ Special Notes and Comments (20) ADDITIONAL LIGHT BOLLARDS AT ENTRY CANOPY. 2007/2008 CALIFORNIA BUILDING CODES. August 19,2010 9:27:27 AM AORTEGA ____________________________________________________________________________ Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 18.49 Fee summary Charged ----------------- .Paid Credited Due ---------- Permit Fee. Total- ---------- — -------- ---------- -314.50 .00 .00 314.50 Plan Check Total 192.43 .00 .00 192.43 Other Fee Total 20.49 .00 .00 20.49 Grand Total 527.42 .00 .00 527.42 LQPERMTT 6� CL C O W 1J V w E Cn ty.. u G fL ❑ E ll 424 U ❑ CV 0 a 'n h fC a a U i w a vi U r z co,1 Col 1-1 46 co U Lu owQ -. U¢ O d U F a co V L O O lh VVV 2 E a y 9 c c 9 4 N V to SV O 'e ❑ ' R E E cd C4 V c, P. iv U a c J � 6G © �' � a 77 ✓� Q N N W N. 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