PAT (04-5638)�� • BUILDING & SAFETY DEPARTMENT
(760).777-7012
Of fl 78- 5 TAMPICo f FAX (760) 7771-7011
LA .QUINT LIFORNIA 92253 INSPECTION. REQUESTS (760) 777-7153
JUL 2 3 2004 BUILDING PERMIT
CITY OF LAQUI14TA
FINANCE DEP4 ---7::
App mber 04 -w -&00056 3`8j Date" 7/23/04
Property Address 79948 MORRIS AVE
APN: 604-512-007-1 -24197 -
Application description,. PATIO COVER - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation' 3538
Owner Contractor
LEPE ANDRES PELLETIER CONSTRUCTION
'19948 MORRIS AVE 74691 SWEETWELLROAD,
LA QUINTA CA 92253., THOUSAND PALMS CA 92276
(760) 275-6017
WCC: STATE FUND
WC: 54952004 01/01/05
CSLB:, 260484 12/31/0.4_
CCC: B1 "
Permit . . PATIO COVER PERMIT
Additional de_sc
Permit Fee 63.00 Plan Check Fee 40.95
Issue Date Valuation .3538
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
Special Notes and Comments
266.S.F. ALUMAWOOD,PATIO COVER
Other Fees . . . . . . 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 .50 .00 .0.0 .50
Grand Total 104.45 .-00 00 104.45.
P.O. Box 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253 T-Vf Ot
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
'2J
Architect or Engineer:
4+
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
Lic. No.:
tSUILUING 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
C and my Licer�e is in full force and effect. i ['
icense Class .1� �ense No.
/•Date%I �•3 lo -4 /Contractor
OWNER -BUILDER DECLARATION +.
I. hereby affirm under penalty of perjury that I am exempt 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, 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 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 apply 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
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.).
(, 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 properly 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. , BA P.C. for this reason
Date 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' compenplion insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
S is`� s�ued�My ers' c mpensatio ' urance carrier and policy number are:
amer Policy Number 4't : 1
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 became subject to the workers'
compensationlaws of Califo agree thaty�"� uId become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with tho Provisions / 1
Date 72'3
WARNING: FAILURE TO SECURE WO E ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOLTSAND 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
1 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
Lenders Address
IMPORTANT Application is hereby made to the Director of Building PSafety for
ACKNOWLEDGEMENT to he
and restrictions set forth on this
1. Each person upon whose behalf this application is made, each person at whose request t a dfoor whose benefit works Performed under or pulrsuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La 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 160 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 county to enter upon the above a 'oned property for inspection purposes.
,DSte 7 �31'� S e (Applicant or Agen
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;ILDINO & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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