07-2715 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002715
Property Address: 52220 AVENIDA OBREGON
APN: 773 -255 -001 -1 -000000 -
Application description: PATIO COVER - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 2979
Applicant:
r
T4t 44�0",
Architect or Engineer:
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LICENSED' CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury,that Iam licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, sand my License is in full force and effect.
License Class: - License No.: -
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Date Contractor: —�
O W NER=BUILDEWDECLARATION .
I hereby affirm under penalty of -perjury tfiat ram. exempt from,the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and;Professions Code: Any city pr county that requires'a permit to
.construct; alter, improve, demolish, or repair, any structure, prior to its issuance,.also requires the.applicantfor the
permit to file a signed statemenrthat.he orshe is-iicensed 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
thi t he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section.7631:5 by
an` applicant for a permit subjects the applicant to a civil penalty: of not more than fivehundied dollars'0500).: -
O I, as owner of the property or my.employees with wagesas their sole compensation, will do the work, and
T
the structure isnot intended or offered for sale (Sec: 7044 Business and.Professions Coder The -
Convactors'.State License'Law does not apply to an owner of property who builds.or improves thereon,
and who -does the work himself 6r herself through his or own employees, provided that the '
improvements are notin{end ed or offered for sale. If, however; the building or improvement is sold .within
one year, of completion, the ownr-builder will'have the burden of proving that or she did not build or
improve_ for the purpose of sale!').' -
(_ 1 1, as owner ofthe property,;ain exclusively contracting with licensed contractors to construct the 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, andiwhocontracts for the projects with a contractor(s) licensed
pursuant'to the Contractors' State'License La W.).
(_ 1 I am exempt under Sec. ,_B.&P.C. for this reason
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
Owner:
HARMON GRACIE
52220 AVENIDA
LA QUINTA, CA
(909)376-5296
Contractor:
Owner
OBREGON
92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 10/08/07
D
OCT 08 2007
WORKER'SM
.coPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
-7-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-phe work forwhich 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
insurance carrier and policy number are:.
Carrier - - - - - - - -- - --- - - = - -_-Policy Number
1 certify that, in the performance of the work forwhich 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 should become subject -to the workers' compensation provisions of Section
. 3700 of the Labor Co l shall forthwith`com Iwith those provisions.
Applicant:
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 ($100,0001. 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.
if 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 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
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 buiId'9 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propert,/ inspection purposes
�7 - a
Date' �, 3'U /Signature -(Applicant of7Agentl;
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LQPERMIT
Application Number . . . . . 07-00002715
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Permit. . . . PATIO COVER PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check
Fee
35.10
Issue.•jDate Valuation
. . . .
2979
Exp'irat'ion Date 4/05/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU. BLDG 2,001-25-;000
9:00
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Special Notes and Comments
224 SQUARE, FEET -PATIO COVER--PER
APPROVED -PLANS
Other Fees�
STRONGMOTI
• ON (SMI)
- RES ;.
.50
Fee summary. Charged Paid Credited
Due'
'
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Permit Fee Total 54.00 .00
----------
.00
54.00. -
Plan Check Total 35.10. .00
.00
35.10
Other Fee"Total — .50 .00.
.00
.50
Grand Total 89.60 00
.00
89.60
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LQPERMIT