05-5470 (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:
05-00005470
79897 BARCELONA DR
609-380-999-55 -293234-
PATIO COVER - RESIDENTIAL
LOW DENSITY RESIDENTIAL
5107
T4ht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 700 of Division 3 of the Business and Professionals Code, ano my License (s in full force and effect.
Licens��as/c7/� C�6�1 D3 C51 Licen a 4A42448
Date: /•;/J I' / Contractor:
�[�� OWNER -BUIL R DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason ISec. 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 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 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 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , BAP.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
Owner:
Jessica Lenarth
79-897 Barcelona Dr.
LA QUINTA, CA
LA QUINTA, CA 92253
Contractor:
YBARRA CONSTR CO,'TONY M.
566 STURGEON DRIVE
COSTA MESA, CA 92626
(714)979-5493
Lic. No.: 344248
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.
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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 0653795-2005
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 agree that, if I should become subject to the worker 'compensation provisions of Section
3700 of the Labor Code, hall forthwith comply wit provisions.
D te: Applicant:
WARNING: FAILURE TO SECURE WORKER COMPENSATIO 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.
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 such permit, or cessation of. work for 180 days will subject
permit to cancellation.
I certifytha have read this application and state that the above information is correct. I agree to comply with all
city and unty ordinances and state laws relating to build' g construction, and hereby a ttorize representatives
of this ounty o enter upon the above-mentioned proper for ins pecticurposes.
te: Signature (Applicant or Agent
Application Number . . . . . 05-00005470
Permit. . .
. PATIO COVER
PERMIT
Additional desc .
Permit Fee . . .
. 81.00
Plan Check
Fee
'52.65
Issue Date
Valuation
. . .
. 5107
Expiration Date
6/14/06
Qty •Unit Charge Per
Extension
BASE
FEE
45.00
4.00 9.0000 THOU BLDG
2,001-25,000
36.00
------------------- --------------------------------------------------------
Special Notes and
Comments
Alumawood patio cover 8' x 481.
ICBO
5580
-------------------------------------------------------------------------------
Other Fees . . .
. I. . . . . STRONG
MOTION (SMI)
--RES
..51
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
81.00
.00
.00
81.00
Plan Check Total
52.65
.00
.00
52.65
Other Fee Total
.51
.00
.00
.51
Grand Total
134.16
.00
.00
134.16
LQPERMIT
_ _BUILDING & SAFETY DEPT.
DACE BY
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