07-1086 (CCOM)1 �� IIIIIIIIVIIIIIIVIIIIIII
1E
F
P.O. BOX 1504 –: —
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant: Architect or Engineer:
BUILDING &- SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------- ----------
LICENSED CONTRACTOR'S DECLARATION
I hereb ffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Se n 70001 of Division 3 of th usiness and Professionals Code, and my License is in full force and effect.
ense Class: B License No.: 774293
Dace: ; _O ontractor:
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 ba.sis 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 _ 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 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 I am exempt under Sec. , 8.&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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
4/10/07
Owner:
GREYSTONE CLUBHOU 6SSOC Ilii 11 _ 11
341 BAYSIDE DR STE
NEWPORT BEACH, CA 0 2001
APR ,-
Contractor: CITY OF CEDE r
CEDE
GREYSTONE MULTI -FAM BL
341 BAYSIDE DRIVE, #7
NEWPORT BEACH, CA 92660
(949)566-9230
Lic. No.: 774293
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the fallowing 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 ZENITH INS CO Policy Number Z066293904
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: � pplicant
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 ($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 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 hat I have read this application and state that the above information is correct. I agree to comply with all
cit d county ordinances and state laws relating to building construction, and hereby authorize representatives
this o n�t;:a_tutreeApp1vc.meD.r
n haboe•mwd-property for ' sPection purposes.
Date: iAgent): i (lzz
+
Application Number:
e! 07-00001086
Property Address:
80175 AVENUE 52
APN:
772-410-018- - -
Application description:
CARPORT - COMMERCIAL
'Property Zoning:
HIGH DENSITY RESIDENTIAL
Application valuation:
86184
Applicant: Architect or Engineer:
BUILDING &- SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------- ----------
LICENSED CONTRACTOR'S DECLARATION
I hereb ffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Se n 70001 of Division 3 of th usiness and Professionals Code, and my License is in full force and effect.
ense Class: B License No.: 774293
Dace: ; _O ontractor:
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 ba.sis 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 _ 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 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 I am exempt under Sec. , 8.&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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
4/10/07
Owner:
GREYSTONE CLUBHOU 6SSOC Ilii 11 _ 11
341 BAYSIDE DR STE
NEWPORT BEACH, CA 0 2001
APR ,-
Contractor: CITY OF CEDE r
CEDE
GREYSTONE MULTI -FAM BL
341 BAYSIDE DRIVE, #7
NEWPORT BEACH, CA 92660
(949)566-9230
Lic. No.: 774293
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the fallowing 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 ZENITH INS CO Policy Number Z066293904
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: � pplicant
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 ($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 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 hat I have read this application and state that the above information is correct. I agree to comply with all
cit d county ordinances and state laws relating to building construction, and hereby authorize representatives
this o n�t;:a_tutreeApp1vc.meD.r
n haboe•mwd-property for ' sPection purposes.
Date: iAgent): i (lzz
Application Number . . . . . 07-00001086
------ Structure Information 40 SP METAL CARPORT
-----
Other struct info . . . . . CODE EDITION
01BMP04E05EN
FLOOD ZONE
NO
GARAGE SQ FTG
----------------------------------------------------------------------------
6480.00
Permit . . CARPORT/GARAGE
Additional desc -METAL CARPORT
Permit Fee . . . . 581.00 Plan Check Fee
377.65
Issue Date . . . . Valuation
86184
Expiration Date 10/07/07
Qty Unit Charge Per
Extension
BASE FEE
414.50
37.00 4.5000 THOU BLDG 50,001-100,000
----------------------------"-------------------------------------------------
166.50
Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc . .
Permit Fee 24.75 Plan Check Fee
6.19
Issue Date Valuation
0
Expiration Date 10/07/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
9.75
------------------------------------ ----------------------------------------
Special Notes and Comments
METAL CARPORT (40 SPACES)S-3 OCCUPANCY,
TYPE II -N CONSTRUCTION 2001 CBC 2004
CEC.
-=--------------------"------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -COM
410.92
STRONG MOTION (SMI) - COM
18.09
Fee summary Charged Paid Credited
-- - - - - - - - - - - - - - ---- -
Due
--- - - ------ - - - - ------ - - - - ---
Permit Fee Total 605.75 00 .00
--- - - - - - -
605.75
Plan Check Total 383.84 .00 .00
383.84
Other Fee Total 429.01 .00 ..00
429.01
Grand Total 1418.60 .00 .00
1418..60
LQPERMIT