04-5589 (PAT)Tit�p 4 4 Q"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . 04-00005589 Date 7/21/04
Property Address . . . . . 45400 ASHWOOD CT
APN: 604-405-007-27 -23995 -
Application description . . . PATIO COVER - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 4469
Owner Contractor
------------------------ ------------------------
MICHAEL BRATCHER OUTBACK PATIO & SUNROOMS, INC.
45400 ASHWOOD COURT 1450 W 6TH STREET, #118
LA QUINTA CA 92253 CORONA CA 92882
(90 9) 272-4997
WCC: STATE FUND
WC: 1423157 02/01/05
CSLB: 483069 10/31/05
CCC: B -C36
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Permit. . . . . . . PATIO COVER PERMIT
Additional desc
Permit Fee 72.00 Plan Check Fee'. 46.80
Issue Date Valuation 4469
Qty Unit Charge Per e sion
BASE FEE .00
--------300--------9_0000-THOU BLDG 2,001-25,000 cO ��27.00
----------------------------- - a -------
�o
Special Notes and Comments c c1 �W
336 S.F. ALUMAWOOD LATTICE PATIO COVER.
-----ICBO # 2621P �*
---------------------------------------------------------
----- c�--------
Other Fees STRONG MOTION (SMI) .50
Fee summary Charged
Permit Fee Total 72.00
Plan Check Total 46.80
Other Fee Total .50
Grand Total 119.30
Paid Credited.
---------- ---------- ----------
.00 .00 72.00
..00 .00 46.80
.00 .00 .50
.00 .00 119.30
P.O. Box 1504VOICE (760) 777-7012
T_af
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: �� 5 Date:
Applicant:.
Applicant's Mailing
Architect or Engineer:
Architect or Engineer's Add
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I here' affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commenting with Section 7000) of Division 3 of the Business and Professionals
and my License ' full force and effect.
icanse Cla/ss I License No. /
7/Zl/64/�.c.r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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.).
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. , 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.
�t have nd will maintain wPrkers' compensati insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ssu�/My wgrk`ers� cgmpensatio rance carrier and
airier � f(� /" ((11„ Policy Number
_ 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 become subject to the workers'
compensation laws of California, and aee�lt /f I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
r fortowith comply with those provifVs. I ,,
ZI fid-(
WARNING: FAILURE TO SECURE WORKERS' 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.).
Lender's Name
Lender's 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, indemnity 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 such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
constructto , ant hereby authorize representatives of this county en er u the ab ve-mentioned pro r inspection purposes.
1 ZI I C) `�
iDa a ignature (Applicant or Agent):
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(800) 37 -PATIO
OUTBACK PATIO & SUNROOMS INC. (909) 272-4997 ;
REAR PROPERTY LINE
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A RE -INSPECTION FEE OF $30 1
WILL BE CHARGED IF THE APPROVED y
L -S PLANS AND !OB CARD ARE NOT ON
I THE SITE FOR A SCHEDULED >,_
INSPECTION.
E NO EXCEPTIONS!
F N
E:
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
3& FOR CONSTRUgFION
9041
V2 2
FRONT PROPERTY LINE -�ulo_.. ??;?I- 7_/0Z_