05-1626 (RER)(�OP.O. BOX 1504
t 78-495'CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:,
Application valuation:
Applicant:
Ct05-00001"626
57591 SANTA ROSA TR
762-240-013-14 ---30487 -
REMODEL - RESIDENTIAL
LOW DENSIT
Architect or Engi
1
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
JUN 0 2 :2005
CITY OF LA ( UINTA
FINANCE DEPT.
' LICENSED -CONTRACTOR'S DECLARATION
I -hereby affirm under penalty of perjury thatI am licensed under. Provisions of Chapter 9 (commencing with -
Sectioih7000) of..DiJision 3 of'thi6,Business and.Professionals.Code, and myaicense is in full .force and. effect. -
LicenseClass: 798228. - License No.: EXEMPT.,.
Contractor
' - OWNER -BUILDER DECLARATION -
-Q.? I hereby affirm under. penalty of perjury that I am,.exempt from the Contractor-sState License Law for the
following reason (Sec. 7031.5:,Business and Professions Code: Any city, or county that requires a permit to
constrIuct, alter;<improve, demolish, or repair -any structure; prior to its issuance, also requires the applicant for, the
perrnitto file a signed statement that he or sheds Ijcensed 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 orshe`is exempt therefrom.and the -basis for the alleged exemption. Any violation:of.Section 703]..5 by
any applicagtfor apermit subjects the applicant to'a civil, penaltyofnot 'more than five hundred -dollars ($500).:
(
)':I, as owner of the property, -or my employees with wages as their sole compensation, will do.ihe'work„and
the structure is -not intended or offered for sale (Sec. 7044, Business and Professions Code:, The;,
Contractors-state'66rise Law does not apply,to an owner 'of property who builds or improves thereon, ,
''arid who.does,the work.himseif. or herself through his or. her own employees,.provided that the.-
, -
-improvements are riot intendedor offered foG'sale: tf, however,.thebuilding or improvement is_sold within
one year of'complefjon, the owner -builder will have the burden of praying that he.or she did•not build or
improve for thepurpose•ofsale.).. .r. .
( - 1_ I, as ownec,of•theproperty,-am exclusiv'.elycontracting;with licensed contractors to construct the project (Sec.
7044,,Business and7Professions:Code The Contractors'State:LicenseLaw 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 _.1 I am exemptyunde.r Sec. , B.&P.C. for this reason
Date: ' Owner:
-T
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
Date: 6/01/05
Owner:
SANTA ROSA DEV
40847 SANDPIPER CT
PALM DESERT, CA 92260
Contractor:
------------
GREYHAWK, INC.
1603 TRASKE ROAD
ENCINITAS, CA 92024
Lic. No.: EXEMPT
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of. perjury one of the: followingdeclarations i
I have and will maintain,a certificate *6i consent to self -insure for workers' compensation; as provided
for by Section•3700 of the Labor Code, for the performancewor
of the -k for which this •permit is. ,
Xissued. `.
I have and will maintain workers' compensation insurance, as required by Section 3700 of.the Labor
Code, fbvttie`performance of -the work for,which this permit is, issued. My workers 'compensation
insurance carrier and policy number are:'. - -
Carrier 1031. Policy Number EXEMPT
_ I certify that; in.ihe 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.1 should become.subject to the workers%compensation.provisions of Section
3700 of the Labor Code, I shall. forthwith comply with those provisions.-
0 /Date: Applicant:,
-iWARNING:. FAILURE TO, SECURE'WORKERS'.COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
]`SUBJECT -AN EMPLOYER TO CRIMINADPENALTIES:AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
DOLUARS,($100,000). IN ADDITION TO.THE-.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, -INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT .Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions -and restrictions set'forth on this application... ,
1. Each person upon whose behalf .this application is made, each person at whose request and for
whose benefit workisperformed under,or pursuant to, any permit.issued as a result of this application,
the owner, and the applicant,'each,agrees to, and shall. defend, indemnify and hold harmless the City
ofLiQuinta, its officers,. agents and employees for any actor;,omission related to the work being
performed under or following.issuance of this permit. -
2. Any permit issued as a result of this application becomes null: -and -void if work is not commenced
within 180,days from date of issuance ooinformatibn
s 'on of work for 180 days will'subject
'permit to cancellation. -I certify that I have, read this application and state thattibn is orrect. I agree to comply with all
city and county ordinances and state laws relating t n, an hereby -authorize representatives
of thisccouunty to enter upon the above-mentioned rap p . ose
DW" Signature (Applicant or Age
}
Application Number. . . . . 05-00001626
r.
Permit . . BUILDING PERMIT
Additional desc .
Permit Fee. .... 21.00 Plan Check
Fee
13.65
Issue Date_ . . . . Valuation
798
Expiration Date 11/28/05
Qty Unit Charge Per
Extension
' BASE ,FEE
15.00
3.00 2.0000 HND BLDG 501-2,000
6.00
------- -------- --------------- ----------------------------
-----Special. Notes Comments
_arid
RESIDENTIAL - COVER$D'ENTRY PORTICO
k ` ADDITION" 60,• SQ: FT.. TO - RESIDENCE LOT, 141.
UNDER CONSTRUCTION PERMIT..04-7375. TYPE
>_V -;N CONSTRUCTION, 2001 CODES':
Other Fees--.--------- .-.- --HOURLY PLAN CHECK -------------70.00----
STRONG-MOTION:.(SMI:)
- RES
.50
Fee:summary ': Charged '.. Paid Credited
Due
• •'---------.------
Permit :Fee= Total 2.1:0.0: .00-
00
21. 00'
Plan Check Total- 13..65 00
.00
13.65;
Other Fee fiotal 70:.50- Yr .00
.-00
70.50
Grand Z, 105 .•15 '' 00.;
�-
,.
.00
1.05:15