08-0948 (CRES)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00000948
Property Address: 477.95 DUNE PALMS RD
APN: 600-020-030- _ -
Application description: CARPORT - RESIDENTIAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 14683
Tii�14400& VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7:153
BUILDING PERMIT
Date: 8/06/08
Owner:
COACHELLA VALLEY HOUSING COALI
45701 MONROE ST 1-G
INDIO, CA 922,01
Applicant: Architecror Engineer:
W011 - alp
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LICENSED CONTRACTOR'S:DECLARATION
I hereby affirm under penalty of perjury that Lam licensed under pro -visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business -and Professionals Code, and my License is in full force and effect.
License Class: R License No.: 396120
Date: _ Contractor:
OWNER-SUILDER DECLARATION
I hereby affirm under penalty of perjury that I em exemptfrom the Contractor's State Ucenso, Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any cityor 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).:
(_) I, as owner of the property„ or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Lew does not apply to anowner of 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.)
(�) I, as ownerof the property, am exclusively contracting with licensed contractorsto constructthe 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 am exempt under Sec. , B:6P:C. PP44 4aapon
VAC
CONSTRUCTION LENDING AGENCY
1 herebyaffirm:underpenalty of perjury that there,(s 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:
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Contractor -
BROWN CONSTRUCTION, INC. IPAUS
PO BOX 980.700
WEST SARAMENTO, CA 95798
(916) 373-9300 5 ZDOe
Lic. No.,: 396120 08
LA
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WORKER'S.COMPENSATION DECLARATION
I hereby. affirm under penalty of perjury one of the"following declarations:
_ Ihave and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code"forthe 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 r which this permit is issued. My workers' compensation
_ insurance.carrierand policy number are:
.
Carrier ZYRICH AMERICAN Policy.Number WC556614800
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 I shouo-Weema.Wbject a-werke ompensation provisions of Section
1300 of -the Lql r�:.�� I 111 forth "f cf omply with those p isions.
ata: 2 f7 plicant: _
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 (5100,000). IN ADDITION TO THEZOST OF -COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE1ABOR 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 requestand 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 omissionrelated to the work being
performed under or following issuance of•this permit.
2. Any permit issued as,aresult 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, we at
is correct. - to comply with
-all
city and ceuntyordlnances and state laws tela " u ding con 'on, and harebyauthorle�antatives
cortntytq enter upon the above-mentio ed p forinspectio 'purpos
ate: gnature.IMplicantor'Ageritl:
r' 7
Application Number . . . . . 08-00000948'
Permit . .
. ELECTRICAL-CARPORT/GARAGE
Additional desc .
.
Permit Fee . .
. 37.08_ Plan Check Fee
9.27
Issue Date . . .
. Valuation . . . .
0
Expiration Date .
. 2/02/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1104.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
22.08
Permit . .
. CARPORT/GARAGE
Additional desc .
.
Permit Fee . . .
. 162.00 Plan Check Fee
105.30
Issue Date . . .
. Valuation . . . .
14683
Expiration Date .
. 2/02/0.9
Qty Unit Charge Per
Extension
BASE FEE
45.00
13.0-0 9.00,00 -THOU BLDG 2,001-25,000
117.00
Special Notes and
Comments
6 STALL TILE ROOF
CARPORT, 1104 SF. @
BLDG. 1100 PARALLEL TO DUNE PALMS ROAD
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Other Fees .
--
. . . . . . STRONG MOTION (SMI) -:RES
1.46
Fee summary
Charged Paid Credited
Due
Permit Fee Total
19.9.08. .00 .00
199.08
Plan Check Total
114.57 .00 .00
114.57
Other Fee Total
1.46 .00 .00
1..46
Grand Total
315.11 .00 .00
315.11
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