09-1066 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT'
> -- - • BUILDING PERMIT
_Application Number: 09-00001066' Owner:'
Property Address: 78549 TORINO DR HOLLANDS RESIDENCE
APN: 609-551-003-7 -28458 Z, 78549 TORINO-DR
Application description: PATIO COVER - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2700
Applicant:. Architect or Engineer:
� l Ir v
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I ap, licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the.Busi e s al Professionals Code, and my License is in f .ce-and effect.
License Class: D03 License
Date:0/6/01Contractor:
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 statem6nt 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, -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.). " -
(_ 11, 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.).
( 1 1 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:
LQPERA1IT
Contractor:
ATLAS AWNING & SCREEN,
~ 754 S.'WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)327-8466
Lic..No.: 835140
F3
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/06/09
%i
0c;
E r,•/
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 ENDURANCE WC Policy Number WEN0012731-03
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so t become subject to the workers' compensation laws of California,
and agree that, if I shoul b ome subject to the workers' compensation provisions of Section
3700 of the Labor Cod I all forthwith comply with those provisions.
SII Date: / Applicant: .
WARNING: FAILURE TO SECURE RKERS' COMPENSATION 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 isnot commenced ,
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit -to cancellation.
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 buildi onstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property inspection purposes.
Date: Signature (Applicant or Agent): --
Application Number .
. . . . 09-00001066
- Permit . . .
PATIO COVER PERMIT
-Additional desc .
Permit Fee:
54.00 Plan Check Fee
35.10
Issue Date =.
Valuation . . .
. 2700
Expiration Date
4/04/10.
Qty Unit Charge
Per'
Extension
BASE. FEE
45.00
1.00 9.0000
THOU BLDG'2,001-25-,000
9.00
Special Notes and Comments
15':6 X 13 ALUMAWOOD LATTICE SHADE COVER
._:... :. PER APPROVED. PLAN.
--------------------------
Other Fees
---------------- - - - - --
BLDG STDS ADMIN (SB1473)
--
1.00
Fee summary Charged.
Paid Credited
Due
Permit Fee Total
54.00. .00 .00
54.00
Plan Check Total
35.10 .00 .00
35.10
Other Fee Total
1.00 - .00 .00
1.00
Grand Total.
90.10 .00 .00'
90.10
For: ,
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*,WNING
754 Williams Rd., Palm Springs,, CA 92264.',-' Uc #: 835140LA
PH: 32748466 " ' ' FAX:. 327-8467- ,
Park: Phone:
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Building Permit Application and Tracking Sheet r-
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