08-1335 (CRES) Carport 2P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-vf 4 4 Q"
Application Number: 08-0000133.5
Property Address: 47795 DUNE PALMS RD
APN: 600-020-030- - -
Application description: CARPORT - RESIDENTIAL
Property Zoning- - REGIONAL COMMERCIAL
:Application valuation: 14683
Applicant: Architect -or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
hereby affirm under penalty of perjury that I am licensed under provisions 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: B License No.: 396120
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's StawLicense 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,Law1Chapter. 9 (commencing with Section 7000) of Division 3 of thwBusiness and Professions Code) or
that he or she is exempt therefrom°and the basisfor the alleged exemption. Any violation of Section 7031.5 by
any applicant for alpermlt subjem,the. applicant to -a civil penalty of not more'than five hundred dollars ($500).:
I, as owner of the property, ormy employees with wages as their sole' compensation; will dolthe work, and
the structure isnot 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.).
(�) 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 hot apply to an owner of
property who builds or Improves thereon, and who contracts for the �projeets,with a contractor(s) licensed
pursuant.to the Contractors"State license Law.).
(_) I am exempt -under Sec. , B.&P.C. foYthie�eas�n
ate: 8 2J o �
CONSTRUCTION LENDING AGENCY
hereby affirm under penalty'of perjury that there is a construction lending agency for the performance of the
work for whichthis permit isissued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPE:RMIT,
Owner:
COACHELLA VALLEY
45701 MONROE ST
INDIO, CA 92201
VOICE (760) 777-7012
.FAX (760) 777-7011
INSPECTIONS (760) 777-7153
HOUSING COALI
1-G
Contractor:
BROWN CONSTRUCTION,
PO BOX ,980700
WEST SARAMENTO, CA
(916)'313-93:00
LiC. NO.: 396"120
Date: 8/06/08
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyrof°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, 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 which this,permit is issued. My workers' compensation
insurancecarrier and policy number are:
Carrier. Z!.
RICH AMERICAN Policy Number WC596614800
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 totheworkers' compensation laws of California,
and agree that, if 1 sh9vkH eeorne4wbject,to the workers' compensation provisions of Section
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 ($100i000). 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, andshall defend, indemnity 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
permitto cancellation.
I certify that Lhave read this application and state thatthe above information is correct. I agree to comply with all
city and county' ordinances and state laws relatingttViuildi0g:construction, and hereby authorize representatives
of th' co my1 enter upon eebove-rnert!terte p rty for action p rpos
ett�)y� ature (Applicant or
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date.
Expiration Date .
. . . . 08-00001335
ELECTRICAL-CARPORT/GARAGE
37.08 Plan Check Fee .
Valuation . . .
2/02/09
9.'27
0
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 . . 2/02/09
Qty Unit Charge Per
Extension
.BASE FEE
4.5.00
13.00 9:,0000 THOU BLDG 2,001-25,000
117.00
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Special Notes and Comments
6 STALL TILE ROOF CARPORT #2, 1104 SF.
BLDG. 1200, PARALLEL TO DUNE PALMS ROAD
--------------------------------------------------- -
Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES
1.46
Fee summary Charged Paid Credited
Due
Permit Fee Total 199.08 .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
3.15.11
LQPERMrr