07-1093 (CCOM)_ I�I��IIIVIIIIIIIIIIIIII� 62Tityl 4 •
P.O. BOX 1504 _ - E - - �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
Date: 4/10/07
Application Number: --0-7-00001093 Owner:
Property Address: 80175 AVENUE 52 GREYSTONE CLUBHOUSE ASSOC LLC
APN: 772-410-018- - - 341 BAYSIDE DR STE 7
Application description: CARPORT - COMMERCIAL NEWPORT BEACH, e
Property Zoning: HIGH DENSITY RESIDENTIAL L9266FINOANt-FirIppT. Application valuation: 10773
Contractor: 16 2007
Applicant: Architect or Engineer: GREYSTONE MULTIINC
341 BAYSIDE DRIFLAQUINTA
NEWPORT BEACH,
(949)566-9230
Lic. No.: 774293
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LICENSED CONTRACTOR'S DECLARATION
I hereby um under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with .
Sect 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
L' nse Claassss�'JJ: B License No.: 774293
Date. ( �ctor: /1/�-
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 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 notapply 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, 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 _ 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
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WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
1 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 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 hoGl�become subject to the workers' compensation provisions of Section
3700 of th or Cold//e,J_1 shall forthwith
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 ($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 Ouinta, 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 �-cancellation.
certify that vie read chis application and state that the above information is correct. I agree to comply with all
city an unty ordinances and state laws r o building construction, and hereby authorize representatives
of s co�;?;?,,,upon the ab entioned property for inspen purposes.
Date: ure (Applicant or Agentl�//4s
I�
f �1
Application Number . . . . . 07-00001093
------ Structure Information 5 SP METAL CARPORT
-----
Other struct info . . CODE EDITION
O1BMP04E05EN
FLOOD ZONE
NO
GARAGE SQ FTG
--------------------------------------------=-------------------------------
810.00
Permit . . . CARPORT/GARAGE
Additional desc METAL CARPORT
Permit Fee . . . . 126.00 Plan Check Fee ..
81.90
Issue Date Valuation
10773
Expiration Date 10/07/07
Qty 'Unit Charge Per
Extension .
BASE FEE
_ 45.00
9.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
81.00
Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee 16.50 Plan Check Fee
4.13
Issue Date Valuation •
0
Expiration Date 10/07/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1.50
----------------------------------------------------------------------------
Special Notes and Comments
METAL CARPORT (5 SPACES [1 HC])S-3
OCCUPANCY, TYPE II -N CONSTRUCTION 2001
CBC 2004 CEC.
-------------------------------------- --------
Fees . . . . . . . . . ART IN PUBLIC PLACES -COM
33..86
STRONG MOTION (SMI) 7 COM
2.26
Fee summary Charged Paid Credited.
----------------- ----------
Due
---------- --- - ------ ----------
Permit Fee Total 142.50 .00 .00
142.50
Plan Check Total 86.03 .00 .00
86.03
Other Fee Total 36.12 .00 00
36.12
Grand Total 264.65 .00 .00
264:65
LQPERMIT