08-0841 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Ti'lt 4 4 Q"
Application Number: 08-00000841
Property Address: 47795 DUNE PALMS RD
APN: 6.00-020-03.0- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: REGIONAL COMMERCIAL
Application Valuation: 14.0000
Applicant- , Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter'9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my Licenseis in full force and effect.
License Class: B License No.: 396120
Date: Contractor:
OWNER-BUILDERDECLARATION
I hereby affirm under penalty of perjurythatI am exempt from the Contractor's State, License Lew for the
following reason (Sec. 703.1.5, Business and Professions Code: Any city or county that requires a permit to
construct, after, improve„ demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit:tofile,a signed statement that he or she is,licensed pursuant to the provisions of the. Comracfor's'Stete
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 applieam:for a permit subjects the applicant to a civil penalty of not more than five.hundred dollars (8,500).:
1—) I, as owner of the property, or my employees. with wages:as their sole compensation, will do the worki and
the structure is not intended or offered for sate (Sec. 7044,.Business and Professions Code: The
Contractors' State License Law does not apply to an ownerof property who builds or improves thereon,
and who.does the work himself or herselfthrough 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 Lew does not epply.to an owner of
property' who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P Fi-fe*4g%.reason
Date:
Owner:
I hereby affirm under penalty of perjury that there is'a cor
work for which this permiois issued (Sec. 3097, Civ. C.).
Lender's Namw _
Lender's Address:
LQPSRMIT
LENDING AGENCY
in lending agency for the performance of the
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/21/08
Owner:
COACHELLA VALLEY HOUSING COALI
45701 MONROE ST 1-G
INDIO, CA 92201
Contractor:
BROWN CONSTRUCTION, INC. n d
PO BOX 98070'0
WEST SARAMENTO, CA 9.579
(916)373-930.0
Lie. No.: 396120 JUL 2 12008
In
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 9700. of the. Labor Code, for the performance of the work for which this permit is
ad
��issu,
0 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 carrierand policy number are:
Carrier ZURICH AMERICAN Policy Number WC596614800
_ I certify that, in the per of the work for which this permit: is issued, I shall not employ any
person insany manner so as to become subject to. the Workers' compensation laws of California,.
and'agreethat, if 1 should become subje • ' compensation provisions: of Section
3700 of thedzWree - s t th h comply with tho ovisions.
Date: j"� Applica
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP70.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 madeto 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 Quints, 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 H work isnot 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 ion, roYy wt representatives
of this county o enter upon the above-mentior.w6i for inspecti rposes.
Dater ZR �O Signature (Applicantor Agent):
Application Number . . . . . 08-00000841
Permit . . . BUILDING PERMIT
Additional des_c . .
Permit Fee . . . . 779.50 Plan Check Fee
506.68
Issue Date . . . . Valuation . . .
. 140000
Expiration Date . . 1/17/09
Qty Unit Charge Per
Extension
BASE FEE
639.50
40.0.0 3.5000 THOU BLDG 100,001-500,0.00
----------------------------------------------------------------
140.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . 44.40 Plan Check Fee
11_.10
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 1/17/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
15..00
32.00 .4500 EA ELEC DEVICE/FIXTURE >20
14.40
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Special Notes and Comments
(52) LIGHT STANDARDS W/FOUNDATION
[ENGINEERED] 2001 CALIFORNIA BUILDING
CODE. THIS PERMIT DOES,NOT INCLUDE
CARPORT LIGHTING, PEDESTAL LIGHTS OR
PEDESTRIAN LIGHTING IN MASONRY WALLS.
July 2, 2008 3:16:21 PM AORTEGA
-----------------.--- �------------------------------------------
Other Fees . . . .. . . . ENERGY REVIEW FEE
---------- ---
50.67
STRONG MOTION (SMI,) - COM
29.40
Fee summary Charged Paid Credited
Due
Permit Fee Total 823.90 .00 .00
823.90
Plan Check Total 517.78 .00 .0.0
517.78
Other Fee Total 80.07 .00 .00
80.07
Grand Total 1421.75 .00 .00
1421.75
LQrERMe