04-3440 (PAT)i'
i
1
�ffJ BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
0FT1 9 7.8-495 -,CALLE.TAMPICO FAXJ7,60).777-7011
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LA QUINTA,.CALIFORN1A.92253 INSPECTION REQUESTS,(.760) 777-71.53
,BUILDING PEWIT
Application Number .. 04- 3440 Date 4/16/04 .
Property Address .78905 MORNING STAR CT
APN:609=5:60-0'5'1=51 -23773---
Application description . . PATIO COVER - RESIDENTIAL
Property Zoning . . .' ..LOW.DENSI.TY.RESIDENTIAL
Application valuation 2461
Owner Contractor
ERIN DOUGHERTY PELLETIER CONSTRUCTION
78905"MORNING STAR COURT 74691 SWEET WELL ROAD
LA QUINTA CA 92253 THOUSAND PALMS CA 92276
(760) 989-.0925 (T60).275. -6Q17
WCC: STATE FUND
- WC,; 54952004 01/.01/05..
CSLB: 260484 12/31/04
CCC: B1
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Permit PATIO COV ER'PERMIT "
Additional-desc
...Permit. Fee: .54.00 Plan Check'Fee' 35.10
Issue Date, Valuation 2461
Qty Unit Charge Per. Extension
BASE FEE 45..00
1:.010 9:0000 THOU BLDG 2,001-25.000 9.00
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Special Notes and Comments
185 SF. ALUMAWOOD..LATTICE PATIO COVER @. -�
REAR OF HOUSE';
,.Fee summary Charged "Paid Credited Due
Permit Fee. Total 54.00 :b0 .00 54.:00
Plan.Check Total' 35.10 .00 .00 35.10
Grand Total 89.10 .00 .00 89.10
P.O. BOX 1504 CiF 4
'tit 14
��G1�/ VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 a INSPECTIONS:(760) 7.77-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date: �{
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
l CAV^o.✓ J TyCKER—
Architect or Engineer's Address:
//7 o 4(l p4,0 a✓lr `E
Lic. No.: % 61 2 ;�
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I 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 Licerm;,m3 is in full force and efjaet -. n
License Class IJP
DateL (I U 1c)-I
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury m rpt from the Contractors' State License Law for the following reason.(Sec. 7031.5, Business and Professions Code: Any
City or county that requires a permit to construct, after, 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 Contractors' 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).):
U I, 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 Contractors' State License Law does not appy to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
soli 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.).
U I, 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 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.).
U I am exempt under Sec. , B.& P.C. for this reason
Data Owner
WORKERS' COMPENSATION DECLARATION
I 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 insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issue. My workers' compensation insurance carrier and policy number are:
�Carrier `3 c Policy NumbW_ :1 -141 • Sy 95 aooY
_ I certify that, in the performance of the work for which thisflu issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cafi a9Lee that, if s . Id be me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with provisions.
Date
WARNING: FAILURE TO SECURE W0'RK9-8r'COMPENSATION COVERAGE IS UNLAWFUL, 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 LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
Lenders Name
Lenders Address
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, and shall, defend, indemnify and hold harmless the City of Le Ouinta, 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 cant' ft n.
I certify that I have read this application and state that the ab! ffi ortnatio is corecx I ag7nti,
co with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this c to enter u n the above ned pro rty for inspection purposes.
Date L4 I'x'10'I Signature g (Applicant or Agent): � A 0*—?
;y
D (4� COP Y
e
CITY OF LA QU NTA
BUILDING & SAFETY DEPT.
APPROVE
FOR CONSTRUCTION
DATE -1 y, ` BY
9
A RE -INSPECTION FEE -OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD PRE NOT ON
THE SITE FOR A S HEDULED
INSPECTION.
NO EXCEPTION'31
I A—„,� itru .
voc"D couer
Construction is NOT PERMITTED
on the following Code Holidays:
New Year's Day
Dr. Martin Luther King Jr. Day
President's Day
Memorial Day
Independence Day
Labor Day
Veteran's Day
Thanksgiving Day
Christmas Day
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