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BPAT2016-0078r WORKER'S COMPENSATION DECLARATION �a�w \�. o 78-495 CALLE,TAMPICO I have and will maintain a certificate of consent to self -insure for workers' O. D VOICEt(760) 777-71. LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT FAX (760) 777-70 NS ECfIGNSc60) 777-71 I have and will maintain workers' compensation insurance, as required by v1 Fate: ,6 tractor: Section 3700 of the Labor Code, for the performance*of the work for which this permit ry�'te��Nr/.25/0 lication OWNER -BUILDER DECLARATION Carrier:- Policy Number: _ Owner: �,r0� 19TReiylr Property Addr s : 60959BPAT20FIREOBARREL DR shall not employ any person in any manner so as to become subject to the workers' AYLAR50N APN: 764520026 workers' compensation provisions of SecA37the Labor Code, I shall forthwith 60959 FIRE BARREL DR Application Description: LARSON RESIDENCE / PATIO COVER 520 SF LA QUINTA, CA 92253 Property Zoning: permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERTION COVERAGE IS U Application Valuation: $8,000.00 (_► I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF Applicant: Contractor: ATLAS AWNING AND SCREEN INC ATLAS AWNING AND SCREEN INC 754 SOUTH WILLIAMS ROAD 754 SOUTH WILLIAMS ROAD PALM SPRINGS, CA 92264 PALM SPRIN,QS,;CR:9�264 a (760)327-8466 LIc. No.: 835140 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: D03 License No.: 835140 of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by v1 Fate: ,6 tractor: 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: OWNER -BUILDER DECLARATION Carrier:- Policy Number: _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, • 1 should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of SecA37the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to. the provisions of the comply with those provisions. 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 is exempt therefrom and the e: Abglicant: 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 WARNING: FAILURE TO SECURE WORKERTION COVERAGE IS U ($500).: • AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_► I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, willdo the work, and the structure is not intended oroffered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_J I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'. issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (� I am exempt under Sec. , B.&P.C. for this reason 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. 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 Lender's Address: 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 city to ter upon the above-mentioned property for inspection purposes. gate`�712 �/G Seture (Applicant or Agen DESCRIPTION FINANCIAL •• • ACCOUNT* QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/25/16 PAID BY METHOD, . RECEIPT # CHECK # CLTD BY ATLAS AWNING AND SCREEN INC CHECK R17338 8484 MFA Total Paid for -BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT. PAID PAID DATE PATIO COVER, STD, OPEN 101-0000-42404 0 $97.17 $97.17 7/25/16 PAID BY: METHOD _ RECEIPT # CHECK # CLTD BY ATLAS AWNING AND SCREEN INC CHECK R17338 8484 MFA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PATIO COVER, STD, OPEN PC 101-0000=42600 0 $95.72 95.72 7/25/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ATLAS AWNING AND SCREEN INC CHECK R17338 8484 MFA • Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $192.89 $192.89 DESCRIPTION - ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $1.04 $1.04 7/25/16 PAID BY . METHOD RECEIPT # CHECK # CLTD BY ATLAS AWNING AND SCREEN INC CHECK R17338 8484 MFA Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.04 $1.04 TOTALS: Description: LARSON RESIDENCE / PATIO COVER 520 SF Type: PATIO COVER Subtype: CITY STANDARD/PRE- Status: ISSUED Applied: 7/20/2016 MFA ENGINEERED - OPEN Approved: 7/22/2016 DCL Parcel No: 764520026 Site Address: 60959 FIRE BARREL DR LA QUINTA,CA 92253 Subdivision: TR 30023-5 Block: Lot: 63 Issued: 7/25/2016 MFH Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $8,000.00 Occupancy Type: Construction Type: Expired: 1/21/2017 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 ACTION DATE Details: 520 SF PATIO COVER [ALUMAWOOD] CARL PUTNAM ENGINEERING. THIS PERMIT DOES NOT INCLUDE ELECTRICAL INSTALLATIONS. PER 2013 CALIFORNIA BUILDING CODES. j Applied to Approved Approved to Issued Printed: Monday, July 25, 2016 9:29:59 AM 1 of 2 ` sys•reMs ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK SUBMITTAL MARY FASANO 7/20/2016 7/20/2016 RECEIVED TELEPHONE CALL DUANE CLAYTON 7/22/2016 7/22/2016 CONTACTED ATLAS AWNINGS AND INFORMED THEM PLANS ARE READY FOR PICK UP AND PERMIT IS READY TO ISSUE. CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT' ATLAS AWNING AND SCREEN INC 754 SOUTH WILLIAMS PALM SPRINGS CA 92264 (760)698-8205 MARK@ATLAS- ROAD AWNING.COM CONTRACTOR ATLAS AWNING AND SCREEN INC 754 SOUTH WILLIAMS PALM SPRINGS CA 92264 (760)698-8205 MARK@ATLAS- ROAD AWNING.COM OWNER JAY LARSON 60959 FIRE BARREL DR I LA QUINTA CA 92253 1 (760)698-8205 Printed: Monday, July 25, 2016 9:29:59 AM 1 of 2 ` sys•reMs Printed: Monday, July 25, 2016 9:29:59 AM 2 of 2 SYSTEMS O. CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/25/16 R17338 8484 CHECK ATLAS AWNING AND MFA SCREEN INC Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: PATIO COVER, STD, 101-0000-42404 0 $97.17 $97.17 7/25/16 R17338 8484 CHECK ATLAS�AWNING AND MFA OPEN SCREEN INC PATIO COVER, STD, 101-0000-42600 0 $95.72 $95.72 7/25/16 R17338 8484 CHECK ATLAS AWNING AND MFA OPEN PC SCREEN INC Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $192.89 $192.89 SMI - RESIDENTIAL 101-0000-20308 0 $1.04 $1.04 7/25/16 R17338 8484 CHECK ATLAS AWNING AND MFA SCREEN INC Total Pid for STRONG MOTION INSTRUMENTATION SMI: $1.04 $1.04 $194.93 $194.93 Printed: Monday, July 25, 2016 9:29:59 AM 2 of 2 SYSTEMS ! �e q�vr�9__._TY�trv6 y , + , JL + PC 1006's J M�a { i i i i � I 1 1 •! � 1 r ! ! r i ! ' i + , _f j�I }.u.... f CITY 4F LA; QUINTA BUILDING &;SAFETY -DEPT, _`APPROVED ' f FOR CONSTRUCTION DATE. BY i 1R WSL_ c b.o 9sq 1 2e pq okFc A04 (le I .70 fole i 709 i "L,.� Ci Ig ,� v.92•�. S`f1E iG : ',j /� '3 C.44e4 P6 .3a X33 .J�GD -v&/6 'lab 903 / .le'��e .oe2✓ �U ora �i...�b 69. CTe:4#r� - 4orr6 �6. a ,, w':.. � .. Q , 3 a� ' x [Jlrw �/e /�90e2Jw Jyn�fo G.�� 'l6 6Lt C. t��'gyi.� -�►� . 3 a Bin #City of La Quin is . Building & Safety Division Permit # I 6lJJ P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: $ Owner's Name: dM - L O A. P. Number: Address: 60 Legal Description: City, ST, Zip: WM79, Tele hone:?'>:;:;.:;;::::>:;<::::;::.•:<:: P Contractor: a-- Address: Yb Project Description: City, ST, Zip: 1 Telephone D State Lic. #: City Lic. k Arch., Engr., Designer: Address: City., ST, Zip: Telephone: «:v:;:>_> ...or ................................... Construction Type: Occupancy: YP P Y: State Lic. #: Project type (circle one) New Add'n Alter Repair Dcmo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone #,of Contact Person: 00 Estimated Value of ProjCtfo It Submittal Req'd APPLICANT: DO.NOT WRITE BELOW THIS LINE Rcc'd TRACKING PERMIT FEES Plan Sets PIan Check submitted Item Amount. Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for. corrections/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Decd. Plans picked up S.M.I. 11.0 A. Approval Plans resubmitted Grading IN 11- -USE:- ''J Review, ready for corrcctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P.. Pub.-Mks. Appr Date of permit issue Scllo61 Fccs Total Pcrmit Fccs 609 1�2 �,92lc�c l��ev I P • v t', k-r)v4It e sieti c. �GJ}""! /,^Jce6-eo j'oorr.v 6 ✓ or, . 3o� 3 f B `� S' v� 2 �,= S' r=C �,lY✓ //J2� c�i�e� �� ��ti6 � 30, 31 C 3� �ov6�e 13�P2✓ W li 3 �8 '" Oov Re /�Pgoe2,/ w ,Syrjfo 4x C. req 106. :30 E 3 T210 to i9nj EG ! {v1516N 1 CITY OF LA QUANTA BUILDING & SAFETY DEPT. APPROVE® OR CONSTRUCTION DATE9lq /;t)o lk CA CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED _ FOR CONSTRUCTION DATE BY BY V s609S9 'I've09. G 9 Ig '• .� tiS�t/� � �; Sf�ti G• ��J�J /� C��O FoaTr.v.� ✓ 1�6 �. 30� 3 l //J30, 3 / C 3 � /Jo(j 6 l 1-e9,oP2J w t 66 .4 cCe-oJ*'?7 jr P(. 2) Q . 1J .3 d-8 '' 0o ale SW J(p G OF 16. Cl, �,g lam, �6. 30 t Kf-uIs IQ rJ CITY OF LA QUANTA BUILDING & SAFETY DEPT. APPROVED FOR C) CONSTRUCTION DATE �S I -i 1f7�/I�Y- sS�s s a Gbf �Pf���- 06 �t oli7 7 �4rrlIA. L �i9 7/GD6 y Noyol coue12 g i a ` __.._...-. -- _ 7` 166 p _— — — — — — — — —'— — — — — —.— — —.- r pGbEq Pa. ocop 6e�loy L..S. ¢6V1$10nJ CITY OF LA QUANTA BUILDING & SAFETY DEPT: APPROVED. FOR CONSTRUCTION DATE I1 lmi By o c, '3>Pf- 1 b �- (5arlg