04-4760 (PAT)C &hf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495tALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Application Number.
Property Address . . .
APN:
Application description
Prbperty Zoning ...
Application valuation
Owner
PAT WALLS
43515 CORTE.DEL'ORO
LA QUINTA, CA
BUILDING PERMIT
. . . 04-00004760 Date 6/03/04
43515 CORTE DEL ORO
609-580-039-
PATIO-COVER
09-580-039-PATIO COVER - RESIDENTIAL
LOW DENSITY RESIDENTIAL
. . 4735
LA QUINTA CA 92253.
Contractor
---------- ----------
YBARRA CONSTR CO, TONY M.
566 STURGEON DRIVE
COSTA MESA CA 92626
'�A 0 3 2004
WCC:
STATE FUND
WC:
6537952004
01/01/05
CSLB:
344248 .
04/30/05
CCC:
C61-D3-C517.D24
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Permit . . . . . PATIO COVER
PERMIT
Additional desc,. .
Permit Fee. 72.00
Plan
Check Fee
46.80
Issue Date
Valuation
4735
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU ,BLDG
2.,001-25,000
27.00
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Special Notes and Comments
356 ALUMAWOOD PATIO COVER PER APPROVED
PLAN.
----------------------------------------------- ------------------------------
Other.Fees . . . . . . . STRONG MOTION
(SMI) - RES
.50
Fee summary Charged
..Paid Credited
Due
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total 46.80
.00-
.00
46.80
Other Fee Total .50
.00'
.00
.50
Grand Total 119.30
.00
.00
119.30
'�A 0 3 2004
P.O. Box 1504�� VOICE (760) 777-7012
Taf
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 % Date: O¢
Applicant:CoN Architect Or np�r: !T
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice a is in full force and effect.
License Class rn / License No.If
Date '!1% Contractor ��-
OWN R-SUIL.DER DECLARATION
I hereby affirm under penalty of perjury that I 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 fora 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 1, 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.
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
y pensation insurance camer and oliyy nu r d� , - L p
Carrier �� rers c Policy Number - SJ G� /
_ 1 certify that, in the performance of the work for which this permit is issued, I shall note ploy 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 workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date 1106 Applicant l
WARNING: FAILURE TO SECURE WORKERS' COMPEN AT
COVERA IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA S ($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
Lenders 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 ddy>t 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 comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent): �_
Taffy M. Ybwm
�
Wnsv Co.
566 Suncon Dr.
PLOT PLAN
Cost& Mesa. CA 92626-3145
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