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11-1025 (PAT)P:O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property,,Address: APN: Application description Property Zoning: Application valuation: Applicant: 11x'_0000.1.0.2.5 53085 AVENIDA RUBIO 774-042-016- - - PATIO COVER - RESIDENTIAL COVE RESIDENTIAL 3937 Tit!t440", BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: CHRISTENSEN MICHEAL 53085 AVENIDA RUBIO LA QUINTA, CA 92253 ( Contractor: Architect or Engineer: GOLD STAR CSTM' PTG LQ PAT 42335 WASHINGTON ST #F363 PALM DESERT, CA.92211 (760)574-1043 Lic'. No.:`855623 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/21/11 2011 Z A 54,ilINTA ------------------------------------------------------------- " LICENSED CONTRACTOR'S DECLARATION ------------------------------------ WORKER'S COMPENSATIOWDECLARATION ' I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9.Icommencing with - I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, andMyLicense is in full force and effect. License Class:.C33 C51- Lice se,No.:' 855623 �J - _ 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. y` ),' . ater-` Contractor: -� �D J " CID 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 issued-. My workers' compensation - OWNER -BUILDER CLARATION - insurance carrier and policy numberare: I hereby affirm under penalty.of perjury that I am exempt.from the Contractor's State Licens&Law for the Carrier STATE FUND Policy Number 193290309' following reason (Sec. 7031.5; Business and Professions Code: Any city or county that,requires a,permit to construct, alter, improve,'demolisli;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 Eontractor's State I License. Law (Chapter 9 (commencing with Section 7000) of.Division3 of the"Business and Professions Code) or - I certify that, in the performance of the work for which this permit is issued„Isha11 not employ any person in any manner so as to become subject to the workers'.compensation laws of California, and agree that; if should become subject to the workers' compeiisation.provisions of Section 3700 of the Labor Code. I shall forthwjtNcomdly with those w4visions. that he or she is exempt therefrom and the basis for,the alleged exemption. Any violation of Section 7031.5 by any applicant fora permitsubjects the applicant to -a cNil.penalty of not, more than five hundred dollars ($500).: (_ 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 .(Sec. 7044, Business end Professions"Code:.The _ Contractors' State License Law does not apply to an owner of property who builds .orimproves 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.l. (_ 1 I, as owner of the property, am exclusively*contractingwith 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.). (_ 1 1 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: LQPERAIIT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEAAAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND.CIVIL FINES.UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001 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 thisapplication. -1. Each person upon whosebehalf 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 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 omply with all city and county ordinances and state laws relating to building construction, nd hereby authoriz epresentatives of this court y.toe ter upon the above-mentioned pr r inspec 'o rpose �/- Dafe:�� (: Signature (Applicant or,Agentl: � ��,.. LQPERMIT Application Number . . . . . 11-00001025 Permit . . . PATIO COVER PERMIT Additional desc . Permit Fee . . 63.00 Plan Check Fee 40.95 Issue Date . . . . Valuation . . . . 3937 Expiration Date 3/19/12 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9:000.0 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special,Notes,and~Comments ALUMAWOOD SHADE STRUCTURE -PER APPROVED :`PLANS;;.PER- 20.09 ,IBC•; ,2,0.09::�3•RC;.,' 2010- CBRC: r, c6DES.TOTAL OF 296 :SQUARE FEET. --------------------------------------------------------------- Other Fees BLDG STDS ADMIN-(SB1473') 1.0.0 ' Fee summaryCharged Paid Credited Due ` Permit Fee Total 63..00 .0.0 .00 63.00 Plan Check Total 40.,95 :00 00 40:95 .Other.Fee•Total 1:00 .00 .00 1'.00 ' Grand Total 104.95 .00 :00 104.95 LQPERMIT Bin # City of La Quinta Building 8l; Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777.7012 Building Permit Application and Tracking Sheet Permit # 101, Project Address: jf j Og� he411PV eV/�� D Owner's Name: %�( �HF A. P. Number: Address:j/ Legal Description: City, ST, Zip: 4 U I ti % A C -A 'FZZ s 3 Contractor: AV 11-0 WL C , (! ph -I >r-Ilu Telephone: / Address: f2 -33 (,, p6 ffI s-(?� 3/-3 Project Description: City, ST, Zip: )'cs_ (I., C.5 —r"q- t C-4 - 4 zz- I t A/471tJ TT/ �- Telephone: 7(,o-5-74-1 ;..:,y;,:•;it•:vs.,:°lS�� 5/ i2(JGT[/AF— State Lic. # :,$S(oZ3 City Lic. Grading Arch., Engr., Designer: IN HOUSE:- Address: City, ST, Zip: Telephone: ,.. V �� :>�:f:��,.?.'.f/�.:<�%s.:•.:•>4: Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: `/ ��0 J�/ M 0 L,[ u 14 Sq. Ft.:7,.'71,1 # Stories: #Units: Telephone # of Contact Person: 5 7 q - [ D It 3 •Estimated Value of Project: 35-:2,o all" APPLICANT: DO NOT WRITE BELOW THIS, LINE N Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2". Review, ready for corrections/issue Electrical Total Permit Fees Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 34 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