08-1336 (CRES) Carport 5P.O. BOX 1504
78-495 CALLE'TAMPICO
LA QUINTA, CALIFORNIA 92253
T-af 4 4 QaAm
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/06/08
Application Number: 08-000013-36 Owner:
Property Address: 4779.5 DUNE PALMS RD COACHELLA VALLEY HOUSING COALI
APN: '600-020-030- - - 45701 MONROE ST 1-G
Application description: CARPORT —RESIDENTIAL INDIO., CA 92201
PropertyZoning: REGIONAL COMMERCIAL D 0
Application valuation: 14683 t1
Contractor: i AUG
Applicant: Architect or Engineer: BROWN CONSTRUCTION, INC. t
PO sox 980700 C�OFLApUIN7A
f WEST SARAMENTO, CA 95798 Inu CEDEP'T-
'1. (916)373-9300
Lip. No.: 396120
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm under penalty of perjury that l 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.: 396,120
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemptirom the Contractor's State License 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 ther 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 isexempt 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
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 burdewof 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 toconstructthe project (Sec.
IT 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 contractsfor the projects with a contractor(s) licensed
pursuant to the,ContractoW State License Law.).
I—) I am.exempt under Sec: , 8:&P17Tf3FYf1hH*,won
ate: $ o "
11*16�
CONSTRUCTION LENDING AGENCY
I hereby affirm underpenaltyof:perjurythat.there is.a construction lending agency for the performance ofthe
work for which this,permit'is issued"(Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERbIIT.
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WORKER?S' COMPENSATIONAECLARATION
1 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
issued.
I have and will maintain workers' compensation insuienoe, 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_ ICH AMERICAN Policy Number WC596614800
1 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.subjeci to the workers' compensation laws of California,
and. agree that, if I s bjeet,to the workers' compensation provisions of Section
370}�0 ofthe e r -o ; I shell'forth 'tit' _rnpl�with-ek rovisions.
Z� 0U licent:
WARNING: FAILU SECURE WORKERS' COMPENSATION COVERAG LAWFUL, AND SHALL.
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE.HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR.IN
SECTION 3706 OF THE.LABOWCODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is.hereby made to the Director -of Building and Safety for a permit�subjectto 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 if°work is not commenced
within 180 days from dateof 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 inf I agree to comply with all
city and county ordinances and state laws relatin to buil ng cons and hereby a ize representatives
of thp' cou ytq ant r,upontha above -men ned, ro rt r iris ction cur es.
ate $ti >/n.ture (Applicant or Agent):
Application Number . . . . . 08-00001336
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 15.0.0
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 45.00
13.00 9.0000 THOU BLDG 2,0.01-25,000 117.00
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Special Notes and Comments
6 STALL TILE ROOF CARPORT #5, 1104 SF. @
BLDG. 8200, PARALLEL TO DUNE PALMS ROAD
---------------------------- -
------------ - -----
Other Fees . . . . . . STRONG MOTION (SMI) RES 1.46
Fee summary
------------
Permit Fee Total.
Plan Check Total
Other Fee Total
Grand Total
15510
Charged. Paid
199.08 .00
114.57 .00
1.4.6 .00
315.11 .60
Credited Due
.00 199.08
.00 .114.57
.00 1.46
.00 315.11