10-0002 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000002
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Property Address:
78073 CALLE NORTE
APN:
770-013-014- .- -
Application description:
PATIO COVER - RESIDENTIAL.,
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
5599
Applicant:
Architect or Engineer:
N�
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, an my License is in full force and effect.
License Class: C51 icense 449379
Date:
OWNER-BUI Lod 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 ($500):
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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
Owner:
SAMPSON KEVIN
78073 CALLE NORTE
LA QUINTA, CA 92253
(714)331-2391
Contractor:
LA QUINTA PATIO COMPANY
40133 CALLE LOMA ENTRADA
BERMUDA DUNES, CA 92203
(760)863-4335
Lic. No.: 449379
VOICE (760) 777-7012
FAX (760) 777-7011 ,
INSPECTIONS (760) 777-7153
Date: 1/04/10
AV 04
row �
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.
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 SOUTHERN INS Policy Number WSII002541901
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 t e workers' compgitsation provisions of Section
3700 of the Labor Code, I all forthwith o ly 'th those p� v,swns.
�., Date: -� '�/Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES P 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 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 coAly with all
city and county ordinances and state laws relating to building construction, nd hereby authorize rep entativ
of this county to enter upon the above-mentioned prope 'nspection rp s.
'Date: . ��U Signature (Applicant or Agent):
Application Number . . . . . 10-00000002
Permit . . . PATIO COVER
PERMIT
Additional desc .
Permit Fee . . . 81.00
Plan Check Fee
52.65
Issue Date
Valuation
5599
Expiration Date 7/03/10
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
421 S.F. ALUMAWOOD LATTICE PATIO
COVER
(ATTACHED TO REAR OF HOUSE) PER APPROVED
APPROVED, ENGINEERED PLANS (2007
CBC).
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------L-----------
Due
Permit Fee Total 81.00
.00 .00
81.00
Plan Check Total 52.65
.00 .00
52.65
Other Fee Total 1.00
.00 .00
1.00
Grand Total 134.65
.00 .00
134.65
LQPERMIT
12/30/2009 15:14 714-680-3298 KEVIN 'SAMPSON PAGE 01
December 14, 2009
Kevin Sampson
1976 Palermo Terrace
Fullerton, CA 92531
RE: 78073 We Norte
Amhltectuml Request
Dear Mr. Sampson:
The Board of Directors has reviewed and approved your request to install an
alumawood cover to the back of the unit, subject to the following condition:
Th® patio colu=9 are not to emeed ton (10) feet iFrom home.
Please note location of Vmaa sprinklen; they znay need to be
relocated.
You may proceed with the work in accordance with all City ordinances and
applicable permits.
Should you have any questions, please feel free to contact us.
Sincerely,
By Direction of the Board of Directors
R e Galla, CCAM
Co unity Association. Manager
MONARCH MANAGEMENT GROUP, LLC. 34 755 Berkey Drive, Butte a
Palm Desert, CA 92211-1106
^�pp' Certified A"Oement Finn ¢ Tel: (760) 776.5100
e� A Division of The Management Trust
Fax: (760) 776.5111
Bin" City of La Quinta
Building M Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Permit # La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: Owner's Name: F ov S d v
A. P. Number: C -4-L-4 Z O - E AddresslV c 73 L' A L LE A) o%Z7C
- ^--- City, ST, Zip: LA 4? 0 i .A� I P+ � f4 1 1?Z Z J— A
Contractor: L U(AJ � r P+7-/ (� GO - Telephone: ( �- "� / --
Address: 40 - (3 3 C1+ LL L` L_c,>M A T A"DA I
Project Description:
City, ST, zip: I N D I O C A, q a o 3 L v vw A- Lx'
Telephone: 7 6O - S74 -1"`i3 qS ,-Q C-7
State Lic. # : cl 3 7 / 1CityLic.#:q9,1/(,:,S_ '_E�b TO 7
Arch., Engr., Designer:
Address:
City, ST, Zip:
Construction Type: Occupancy:
Telephone:
Project ty!4J
e (circle one): New Add'n Alter Repair Demo
State Lic. #:
wo (, Sq. FL: �� # Stories: #Units:
Name of Contact Person: �}- bZ
/ O Estimated Value of Project:
Telephone # of Contact Person: - S 4 — 3
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Rec'd
TRACKING. PERMIT FEES
Amount
Plan Check submitted
Item
Plan Sets
Check Deposit
Reviewed, ----for correctionsPlan
Structural Cates.
Pian Check Balance
Called Contact Person
Truss Calcs. -
Construction
Energy Calcs.
Plans ticked up
Mechanical
Plans resubmitted
Flood plain plan
F
Electrical
2-' Review, ready for correctiondissue
Grading plan
Plumbing
Subcontactor List
Called Contact Person
S.M.I.
Plans picked up
Grant Decd
Grading
Plans resubmitted
fj O A Approval
Developer Impact Fee
''' Review, ready for corrections/issue
1N HOUSE:-
A.I.P.P.
Planning Approval
Called Contact Person
Date of permit issue
Pub. wks. Appr
School Fees
Total Permit Fees