11-0176 (PAT)N
r.. ,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-0000'0176•-1
Property Address: 79455-N_SUNRISE. RIDGE DR
APN: 604-100-023-23 -19903
Application description: PATIO COVER - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3192
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
-TOM ACHTYMICHUK
79455 N. SUNRISE RIDGE DR
LA QUINTA, CA 92253
Contractor:`7 .
Applicant: Architect or Engineer: LA QUINTA PATIO COMPANY
-40133 CALLE LOMA ENTRADA'
INDIO, CA 92203=-0
(760)574-1043
LiC. No..:' 44937.9
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions, of Chapter 9 (commencing with I hereby affirm under •penalty of perjury one.of the following declarations:' .
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C51 enM.: 449379 for by Section 3700 of the Labor Code, for'the performance of the work for which this permit is
issued.
• ate: 1 I C , actor: _ 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
OWNER -BUILDER DECLARATION insurance carrier and policynumberare:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 703 1.5, Business and Professions Code: Any city or county that requires a permit to certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, .
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should 44come subject to the orkers' compens on provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the or Code, I h forthwith comp) ith�h-
that
he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by Z�/'j 1♦ '
any -applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:, ate: •s �• pplicant:
(_) 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, BusinessandProfessions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE�SINLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER,TO CRIMINAL PENALTIES AND CIVIL FINES UP TOE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the .. _ .DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale... If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT .
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety, for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth .on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed _ 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any.permit issued as a result, of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason �- ' the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quima, its officers, agents and employees for any act or omission related to the work being
performed'undef or,following issuance of this permit.
Date: . Owner: - 2. Any permit issued as a result of thisapplicationbecomes 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 _
CONSTRUCTION LENDING AGENCY permit to cancellation.
I.hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree io comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - - city and county ordinances an state laws relating to building construction, a here authorize repres atives
- - - - - - - - - . eofatteewcou9ty to ente(u the above-mentioned property fo spe oppsLender's Name: - - Z��7�(�'. Signature (Applicant or Agent): t
Lender's Address: -
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/17/11
.
. LQPERM[T
Imo\
T
Application Number . . 11-00.000176
Permit PATIO COVER PERMIT
Additional.desc .
Permit Fee . . . . 63.00 Plan Check
Fee
40.95
Issue Date . . . Valuation
'3192
Expiration Date 8/16/11
=Qty Unit Charge .Per
Extension
BASE FEE
45.00
2.00 9.00.00 THOU BLDG,2,001-25,000
18.00
------------- -- ---- -
Special Notes and Comments
INSTALL 240 S.F. ALUMAWOOD LATTICE SHADE
STRUCTURE AT REAR OF SFD..2010 CODES.
---------------------------------------------------------
Other Fees BLDG-STDS P.DMIN'(SB1473)
1.00
STRONG MOTION (SMI)
- RES -
.50
Fee summary Charged Paid Credited.'
Due.
Permit Fee Total 63.00 .00
.00
63.00
Plan Check Total 40.95 .00
.00
40..95
Other Fee Total' 1.50: .00.
.00
1.50
Grand Total 105.45 .00
.00
105.45
LQPERMIT - -
Bin #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Permit # n
La Quinta, CA 92253 - (760) 777-7012
l
Building Permit Application and Tracking Sheet
Project Address: 7 745o," SuAyL1 se °Ri 06-i5 M
Owner's Name: /01M e m / e H is K
A. P. Number:
Address: 77"/5j /(-g, 5 L)/L)
Legal Description:
City, ST, Zip: L-4// h --j/�
Contractor: Z,4 UIN r� P�%/ 0 0-- 1:5> _
Telephone: �Q .- K 7 — j Gf 19
Address: 40 - ( 3 3 Cl+LL t! O /vi ., r1u-t7R
Project Description:
City, ST, Zip: I /tea 1 0 A ct O 3
G(lII.( 2-12-r2b G{q— /t -IE---
Telephone: 7 (,.,9- $- 7 4{- /0"( 3
! zLK 42 7
l :f %
State Lic. # : � 1 13 7
City Lic. / (p s
Arch., Engr., Designer:
Address:
City, ST, Zip:
Construction Type: Occupancy:
Telephone:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: �� WO LL Sq..Ft.: Z qQ # Stories: # Units:
v�
Telephone # of Contact Person: 7 - -7 C4 " / D 3 Estimated Value of Project: �v Z
APPLICANT: DO NOT WRITE BELOW THIS LINE
M Submittal
Req'd Recd TRACKING. PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Reviewed, ready for corrections Plan Check Deposit
Structural CRIcs.
Called Contact Person Plan Check Balance
Truss Calcs.
Plans picked up Construction
Energy Calcs.
Plans resubmitted Mechanical
2" Review, ready for corrections/issue Electrical
Flood plain plan
Grading plan
Subcontactor List
Called Contact Person Plumbing
Plans picked up S.M.I.
Plans resubmitted Grading
Grant Deed
H.O.A. Approval
Review, ready for corrections/issue Developer Impact Fee
IN HOUSE:-
Plauaing Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
-- - -
.. - - 1 1
�� ---1['otaE Permit Fees