07-1090 (CCOM)IIIIIIIIVIIIIIIVIIIIIII 66T4ht 4 4a g
P.O. BOX 1504 - - - -IE - __ 1 um& VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, .CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
r-
07-00001090
80175 AVENUE 52
772-410-018- - -
CARPORT - COMMERCIAL
HIGH DENSITY RESIDENTIAL
8618
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I her by affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
/her
70001 of Division 3 of th Business and Professionals Code, and my License is in full force and effect.
icense Class: Bim/ License No.: 774293
Date: • V 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 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 _ 1 1, 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 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. , 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:
LQPERMIT
Date: 4/10/07
Owner:
GREYSTONE CLUBHOUSE ASSOC LLC
341 BAYSIDE DR STE 7
NEWPORT BEACH, CA 92660
Contractor: Q
GREYSTONE MULTI-FAM-BLDRS
341 BAYSIDE DRIVE, #7
NEWPORT BEACH, CA 92660 APR 16 2007
(949)566-9230
Lic. No.: 774293 Iq CITY OFLAQUINTA
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
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
1 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 o Labor Code I shall orthwith comply with those provisions.
Date: - �! 7 Applicant: Z
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 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 construction, and hereby authorize representatives
,04is co n yy enter upon the bove-mentioned propert for inspection purposes.
Date: v � ignature (Applicant or Agent): / e
Application Number . . . . . 07-.00001090
------ Structure Information 4 SP METAL CARPORT
-----
Other struct info . . . . . CODE EDITION O1BMP04EO5EN
FLOOD ZONE NO
GARAGE SQ FTG
----------------------------------------------------------------------------
648.00
Permit . . . CARPORT/GARAGE
Additional desc METAL CARPORT
Permit Fee . . . . 108.00 Plan Check Fee
70.20
Issue Date Valuation
8618
Expiration Date 10/07/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
7.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
63.00
Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee 15.75 Plan Check Fee
3.94
Issue Date Valuation
0
Expiration Date 10/07/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST -20
.75
----------------------------------------------=-----------------------------
Special Notes and Comments
METAL CARPORT (4 SPACES)S-3 OCCUPANCY,
TYPE II -N CONSTRUCTION 2001 CBC 2004
CEC.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -COM
23.09
STRONG MOTION (SMI) -. COM
1.80
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 123.75 .00 .00
123.75
Plan Check Total 74.14 .00 .00
74.14
Other Fee Total 24.89 .00 .00
24.89
Grand Total .222.78 .00 .00
222.78
LQPERMIT