04-4870 (PAT)T4hf 4 4.4"
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504
(760).777-7012
78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
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9
Application Number
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation
BUILDING PERMIT
q!4=o0-0� 04`870 Date 6/10/04
c:--_7-7-6_15 CALLE POTRERO
774-302-001-24 000000-
. PATIO COVER - RESIDENTIAL
. . COVE RESIDENTIAL
. . . 2514
Owner Contractor
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WADE MARK PELLETIER CONSTRUCTION
-77615 CALLE POTRERO 74691 SWEET WELL ROAD
LA QUINTA CA 92253 THOUSAND PALMS CA 92276
(760) 275-6017
WCC: STATE.FUND
WC: 54952004 01/01/05
CSLB: 260484 12/31/04
CCC: B1
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Permit . . . . . . PATIO -COVER PERMIT
Additional desc
Permit Fee . . . . 54.00 Plan Check Fee 35.10
Issue Date . . . Valuation 2514
Qty Unit Charge Per Extension
BASE FEE 45'.00
1.00 9.0000 THOU BLDG .2,001-25, `000 9,00
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Special Notes and Comments
189 S.F. ALUMAWOOD-LATTICE PATIO COVER.'
Other Fees . . . . . . STRONG MOTION (SMI) - RES .50
Fee summary Charged
Permit Fee Total 54.00
Plan Check Total 35.10
Other Fee Total . .50
Grand Total 89.60
Paid Credited Due
.00 .00 54.00
.00 .00 35.10
.00 QO .50
.00 :'Q0:' 89.60
D ll D
EJUN 0 2004
CITY OF LA QUINTA
FINANCE DEPT.
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 04
Applicant:
Applicant's Mailing Address:
Tdf
BUILDING & SAFETY DEPARTMENT
I hereby affirm under penalty of pequry that 1 am licensed
Code, and my Lice is in full force and effect.
License Class3
L i t,o (o,t
A-
VOICE (760) 777-701. -
FAX
77.701FAX (760) 777-701 ;
INSPECTIONS (760) 777_715--
Architect or Engineer: Date:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
Liun Mvisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
cense No. �)--�/o L -(p, "
I hereby affirm under persalt of
N-1 OWNER -BUILDER DECLARATION
y 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 thepermit 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
the applicant to a civil penalty of not more than five hundred dollars (S500).): for a permit subjects
U 1, as owner of the property, or my employees with wages as their sole compensation, will do the worts• and the structure is not intended or offered for sate (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property
himself or herself or through his or her own employees• provided that the improvements are not intended or ffered for safer improves ve the nbuildi who does pr the wont
sold within one year o1 completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
improvement is
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 1 am exempt under Sec. . BA P.C. for this reason
Date - Owner
I hereby affirm under persalt of WORKERS' COMPENSATION DECLARATION
y 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' compensa .o insurance• as required by Section 3700 of the Labor Code• for the performance of the work for which this permit is
issued. My work r5' compensation i nce Cartier and policy number are:
/Carrier e t w, olicy Number
_ I certify that, in the performance of the work for which this pe i i ued, 1 shall not employ an
y person in any compensation laws of California. and agree that, if I shoul Co subject to the workers' Compensation Provisions onsrOf Sections to b3700 of t e La r COdme subject to #W e�j shall
ii forthwith comply with th' i L
ose pro
/Date (,1lolpc f
�nt
WARNING: FAILURE TO SECURE WORKER ' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSA OLLARS ($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.
I hereby affirm under penalty of perjury that there isa construction lending agency
LENDING AGENCY
for the performance of the work for which this
Lender's Name permit is issued (Sec. 3097, Civ. C.).
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT
Application is hereby made to the Director of Buildingand Safe for a
1. Each Safety permit subject to the conditions and restrictions set forth on this application.
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 pemtit
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 Ottiru. 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 pemliL or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatiori and state that the above information is correct I ag to ply with all city and Count), ordinances and stats laws
construction, and hereby authorize representatives of this court
upon thea noon property for inspection purposes. f9i" to build ft
/Date b � po ��
Signature (Applicant or Agent):
Cify OF LA QUINTA
BUILDINGSAFETY DEPT.
APPROVED
FOR COltSTRUCTiON
DATE. 6•('•o �gy
Pco-c-vro
I --4k at.Al C,*c, GA
A RE-INSP CTION FEE OF. $3C,
WILL BE CH GED IF THE APPROVED 40
PLANS AND 1013 CARD ARE NOT ON
THE SITE FOR A SCHEDULED (9
INSPECTIO *-
N1 EXCEPTIONS!
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