07-2413 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/29/07
Application Number: 07-00002413 Owner:
Property Address: 53000 DEL GATO DR UKLEJA RESIDENCE
APN: 770-330-024- - 53000 DEL GATO DRIVE
Application description: PATIO COVER - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL O
Application valuation: 851
Contractor: p
Applicant: Architect or Engineer: STARK CONSTRUCTION COM NC Q
39725 GARAND LANE, SUITE
C,o PALM DESERT, CA 92211
(760)345-9711
Lic. No.: 577776
9
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 ABusinessProfessionals ode, and my License is in full force and effect.
License Class: B i se No.: 577776
DateW v Contractor-_
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 155001.:
(_ 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 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( I I 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:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 1834492-2007
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,
an agree that, if I should be o4sub'o the workers' compensation provisions of Section
` 3 0 of the Labor Code mply with those provisions.
Dat() Applicant:
WA IN FAILURE TO SECUR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJEC AN EMPLOYER TO CR AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 thisapplicationis 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 certify that I have read this application and state that the above information is correct. I agree to comply with all
city a*nces and state laws relating to building tructio hereby authorize representatives
of thiupon the above-mentioned property i ec ' sas.
Dateignature (Applicant or Agent):
Application Number . . . . . 07-00002413
Permit . . . PATIO COVER PERMIT
f' Additional desc .
Permit Fee . . . . 23.00 Plan Check
Fee
14.95
Issue Date . . . . Valuation
. . .
. 851
Expiration Date 2/23/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 50172,000
8.00
-----------------------------------=----------------------------------------
Special Notes and Comments
64SF PATIO COVER 8' X 8'/V-NR/RES-3
[ENGINEERED] 2001 CBC. October 24,
2007 11:04:50 AM AORTEGA
---------------------------------------------------------------
Other Fees . . . . . . . . . STRONG MOTION (SMI)
- RES
--------------
.50
Fee summary Charged Paid Credited
-----------------------------------------------
----------
Due
Permit Fee Total' 23.00 .00
.00
23.00
Plan Check Total 14.95 .00
.00
14.95
Other Fee Total .50 .00
.00
.50
Grand Total 38.45 .00
.00.
38.45
LQPERMIT
-P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit�/ 4 XP Q"
Application Number:07- 000 02413_
Property Address: 53000 DEL GATO DR
APN: 770-330-024- - -
Application description: PATIO COVER - RESIDENTIAL.
Property Zoning:' LOW DENSITY RESIDENTIAL
Application valuation: \ �► / 851
Applicant: _lkVl✓ Architect or Engineer:
r �„ ►y CCCJJJ"'
C
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Busines d Profess onals Code, and my License is in full force and effect.
License Cla : B License No.: 577776
Dater Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 IS 500).: C
(_) 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 (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.).
l • I I 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:
LQPERMIT
Owner:
UKLEJA RESIDENCE
53000 DEL GATO DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777.7011
INSPECTIONS (760) 777-7153
Date: 8/27/
CTO OFP40Z SU40
Contractor: {t1r10lVF.Vw" " %, i t
STARK CONSTRUCTION COMP
39725 GARAND LANE, SUITE
PALM DESERT, CA 92211 "
(760)345-9711qPW
Lic. No.: 577776
1
------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: 'as -pi Y� T
I have and will maintain a certificate of consent to self -insure for workers' compens ion, asp vided
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 1834492-2006
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 became subject to the workers' compensation laws of California,
and agree that, if I should become subject t e workers' compensation provisions of Section
700 of the Labor Code, I farf�,Z C__1-1____,�/_11
thwi c ly with [hose provisions.
Dat Applicant'`
W NI FAILURE TO SECURE WORK 'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS100,0001. 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 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 1,80 days will subject
permit to cancellation.
1 certify that 1 have read this application and state that the above i formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building c uction, an rby authorize representatives
of this co ty t enter upon the above-mentioned property i echo
Dat M 2
Signature (Applicant or Agent):
' Application Number . . . . . 07-00002413
Permit . . . PATIO COVER
PERMIT
Additional desc .
Permit Fee 23.0.0
Plan Check
Fee
14.95
Issue Date . . . .
Valuation
. .
. 851
Expiration Date 2/23/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
4.00 2.0000 HND BLDG
501-2,000
8.00
----------------------------------------------------------------------------
Special Notes and Comments
PATIO COVER PER APPROVED PLANS 8'
X 8'
------------------------------------------------
Other Fees . . . . . . . . STRONG MOTION (SMI)'-
RES
.50
Fee summary Charged.
Paid Credited
Due
Permit Fee Total 23.00
.00
.00
23.00
Plan Check Total 14.95
.00
.00
14.95
Other Fee Total .50
.00
.00
.50
Grand Total 38.45
.00
.00
38.45 -
LQPERMIT