06-3523 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00003523
Property Address: 79150 HIGHWAY 111 STE 102
APN: 649 -820 -999 -
Application description: REMODEL - COMMERCIAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 4000
Tiht 4 4 Q-ulkz
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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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 Busine and Professionals Code, and my License is in full force and effect.
License Class: B License No.: 476150
t1 0 ractor:
OWNER -BUILDER DECLARATION
I herel . ffirm under penalty of per' y that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, B ness and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolis , 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—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and /000
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.).
(_) 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.).
( ) I am exempt under Sec. , BAP.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:
4.
Lender's Address
LQPERMTT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/02/06
Owner:
FOURTH QUARTER PROPERTIES
45 ANSLEY DR
NEWNAN, GA 30263
(760)613-3783
Contractor:
GREPPIN CONSTRUCTIt.
37925 6TH STREET, EA T #310`'
PALMDALE, CA 935501�y
(661)273-2457 u
Lic. No.: 476150 CITY UFLA_.tff
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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
1issued.
.lhave 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 STATE FUND Policy Number 1770327
_ 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 b e subject to the workers' compensation laws of California,
and agree that, if I should b me bject to th workers' compensation provisions of Section
3700 of the La r Cod shall ith c ly with those provisions.
ate:�4 Iicant:
WARNING: FAILU E TO SECU/WOCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOEREST, 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 applicat' n and state that the above i r tion is correct. 5;��poesentawtives
mplyith all
city and county ordinances and s e laws relating to building nstr do d hereby r
of thisydunly to enter upon above-mentioned propert r ins oses.
(Applicant or
LQPERMIT
Application Number . . . . . 06-00003523
Permit . . . . BUILDING PERMIT
Additional desc .
Permit Fee 63.00 Plan Check
Fee
40.95
Issue Date Valuation
. . .
. 4000
Expiration Date 5/01/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
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Special Notes and Comments
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85" high racks and 48" outer racks for
stock rooms, dsw shoe store.November 2,
2006 10:08:10 AM jjohnson
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Other Fees . . . . . . . . . STRONG MOTION (SMI)
- COM
.84
Fee summary Charged Paid Credited
Due
Permit Fee Total 63.00 .00
.00
63.00
Plan Check Total 40.95 .00
.00
40.95
Other Fee Total .84 .00
.00
.84
.Grand Total 104.79 .00'
.00
104.79