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PAT (11-1230)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 f BUILDING & SAFETY DEPARTMENT ��-- BUILDING PERMIT Application Number: `' -C�l1-000012 0 A Owner: Property Address: 79750 MIRAFLORES BLVD KOLINS APN: 649-470-029-60 -28601 79750 MIRAFLORES BLVD Application description: PATIO COVER RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: MEDIUM DENSITY RES Application valuation: 3751 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 . Date:' 11/14/11 Contractor: rr1J-� Applicant: Architect or Engineer: - LIFETIME PATIOS PO BOX 5806 r 2019 to LA QUINTA, CA 92: I i�`' P 1 U! d l� (760)777-2650 LiC. NO. 770 843 .--- �;('r��-A:'3iSi!�•'i!� LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION r I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Cla B - License No.: 770843 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate: 1 ntractor: 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 OWNER -BUILDER DECLARATION - insurance carrier and policy number are: I hereby affirm under penalty of perjury that l am exempt from the Contractor's State License Law for the Carrier SOUTHERN INS Policy Number WSIO040134-01 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any .construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. 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).: e: plicant: (_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' C OVERAGE IS UNLAWFUL, AND SHALL . Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF. THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _ 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.). - APPLICANT ACKNOWLEDGEMENT (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seo. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractors) licensed 1. Each person upon whose behalfthisapplication is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 1 am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City Date: Owner: ' 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: PC LQPERMIT 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 building construction, and hereby authorize representatives of this coun�re the above-mentioned property for inspection purposes. u�te: Cou (Applicant or gent): Application Number. 11-00001230 Permit . . . PATIO COVER PERMIT Additional desc'. Permit Fee . . 63.00 Plan Check Fee 40.95 Issue Date . . . . Valuation .3751 Expiration Date 5/12/12 Qty Unit Charge Per Extension. BASE FEE 45.00 2.00 9.0000 THOU" BLDG 2,001-25,000 ---------------------------------------------------------------------------- Special Notes and Comments 282 S.F. ALUMAWOOD LATTICE PATIO COVER. 2010 CODES. --------------------------------------- Other Fees . ------------------------ . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due Permit Fee Total 63.00 .00 .00 63.00 Plan Check Total 40.95 .00'. .00 40.95 Other Fee Total 1.50 .00 .00 1.50 Grand Total 105.45 .00 .00 .105.45 Bin # City of La Quinta,o;o Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit .# 'Z Project Address:'.. 79 A. P. Number: Owner's Name,, Address: - City, ST, Zip: Legal Description: Contractor: //FCE71—AC /0S Address: A9 /JOX 5506 Telephone: -% Project Description: City, ST, Zip: 1A 1?V1A)7W64 Ci Telephone: � - Qd /,3 '� ^ ` ' * ` • State Lic. # : /J -T7D9 3. City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: 1 n - a Construction Type: 'Occupancy: Project type (circle one): New Add'n . Alter Repair Demo Sq. Ft.:,M'.. # Stories: # Units: Telephone # of Contact Person: '760 X06$ 700 Estimated Value of Project: v. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance - Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsliissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees