05-4788 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004788
Property Address: 79150 ASHLEY PL
APN: 604-374-007-15 727899 -
Application description: PATIO COVER - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2500
T444t 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perj licensed under provisi s of Chapter 9 (commencing with
Section 7000) of Division 3 of th usiness and Fyfe Is Code, nd n y license is in full force and effect.
LiiccenseClass: B -C33 Lic nse o.: 60484
/Date:i 'Z��ii` nvacto:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury t at I am exempt from the Contractor's 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 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 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).:
1 _ 1 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 ISec. 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 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.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/26/05
Owner:
HERRERA CARLOS G D
79150 ASHLEY PL d 4
LA QUINTA, CA 92253
r) T 2 2005
Contractor: ciryo
PELLETIER CONSTRUCTION RIIyAF1AQ(pNT4
74691 SWEET WELL ROAD E�EPT.
THOUSAND PALMS, CA 92276
(760)275-7593
Lic. No.: 260484
------------------
WORKER'S 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.
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 STATE FUND Policy Number 5495
I certify that, in the perform f the work for which this permit is issued, I shall not employ any
person in any manne o as to bec a subject to th 'compensation laws of California,
and agree that, if I ould become sub ct to the rkers' co pensation provisions of Section
3700 of the Labor ode, I sh rthw comply ' ith those rovisions.
WARNING: FAILURE TO SECURE W KERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA IES 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.
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 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 ermit, or cessation of work pon�ee
ill subject
permit to cancellation.
I certify that I have read this application and sta that the above info ation is correct. Iy with all
city and county ordinances and state laws rela ng to building construct n, and hereby autatives
of th county to enter upon the e-mentio ed property,^ inspecti /Urposes.
VSi ture (Applicant or
Application Number .
. . . 05-00004788
Permit . . .
PATIO COVER
PERMIT
Additional. desc .
Permit Fee . . . .
54.00
Plan Check
Fee
35.10
Issue Date . . . .
Valuation
2500
Expiration Date
4/24/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
1.00 9.0000
THOU BLDG
2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
• 15' X 7' & 16.5' X 5'
ALUMAWOOD
PATIO
COVERS
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . STRONG MOTION (SMI)
- RES
.50
Fee summary Charged
-----------------
Paid Credited
Due
----------
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
LQPERMIT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
to
;r
Bin it
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�A%
Project Address: j o A-> clt R
Owner's Name: Cav to S 4C'W-'- 2L V'h
A. P. Number:
Address: `lc� I S p Ff5�1
Legal Description:
City, ST, Zip:
Contractor: _ z` A �
Telephone: `3L4 5 - -7 6 K
Address: `) ct 27 j D 5'.�r Qin---- 011/-
Project Description:
City, ST, Zip: Q,, �. *` &,4- 92215-3
�w.cc,wc,c9u� y
Telephone: 2-�-� 7 �i
� a
06
State Lic.#: oS&O°t fj City Lic.#:
Arch., Engr., Designer:
1to�Z' x.--' 83 Q
Address:
City, ST, Zip:
Telephoner r `"
State Lic. #: r
Name of Contact Person: �CUVAIIA
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#ESubmit(al
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Check submitted
Item
Amount
al Cates.
Reviewed, ready for corrections
Plan Check Deposit
tes.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'n° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees ` I