05-2114 (PAT)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C 05-00002114
Property Address:
APN: 57595 SOUTH VALLEY LN
Application description: 762-250-009- - -
Property Zoning: PATIO COVER - RESIDENTIAL
Application valuation: LOW DENSIT
Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- 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, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
VOICE (760) 777-7012
FAX (760).777-7011
INSPECTIONS (760) 777-7153
Owner:
---------------------------------
GEYER DOUGLAS L
57595 SOUTH VALLEY LANE
LA QUINTA, CA 92253
"J Contractor:
-----------------------------------
Owner
.� of
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
pMt
signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
Lhapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
tis exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
.aor a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.:
ner of the property, or my employees with wages as their sole compensation, will do the work, and
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
tractors' State License Law does not apply to an owner of property who builds or improves thereon,
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.).
1, as owner,of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contracto 'State License Law does not apply to an owner of
property who builds or improves thereon, and who racts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. B.&P.C. fort ' r s�
Date__
Owner:
--.4
I hereby affirm under penalty of perjury that/there' con
work for which this permit is issued (Sec. 3097 rv. C.I.
Lender's Name: _
Lender's Address:
LQPERMIT
LENDING AGENCY
in lending agency for the performance of the
Date: 5/31/05
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
surance carrier and policy number are:
Carrier_--_- - - - - - - - - - --------PolicyN er
certify that, in the performance of the rk or which this permit is issued, I shall not employ any
t person in any manner so as to bec a je o the workers' compensation laws of California,
and agree that, if I should beco sub he workers' compensation provisions of Section
37 0 of the Labor Code, I sh - w' comply with those provisions.
.—a -
1 Date: / Applicant:
WARNING: AILURE TO SECUR O S' CO SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L PENAL T AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERE T, 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 cessationf'pvork for 180 days will subject
permit to cancellation. f/
I certify that I have read this application and state that the above informatio s c rect. I ee to comply with all
city and county ordinances and state laws relating to building constructio , anre thorize representatives
of this count o e ter upon the above-mentioned property for inspect as
Date: Signature (Applicant or Agent):
Application Number . . . . . 05-00002114
Permit PATIO COVER
PERMIT
". Additional desc".
Permit Fee . . . . 72.00
Plan Check
Fee
46.80
Issue Date
Valuation
4362
Expiration Date" 11/27/05
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
2,001-25,000
27.00
- --- ---------------------------------------------
-- -----------------------
Special
Special Notes and.Comments
7 7 ------------------------
328 SF ALUMAWOOD PATIO COVER
=
------------------------- _------------ ----------- ----------------------------
Other Fees . . . . . . . STRONG MOTION (SMI)
- RES
.50
Fee summary Charged
Paid Credited
Due
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total 46.80
.00
.00
46.80
Other Fee Total .50
.00
00
.50
Grand Total 119.30
.00
.00
119.30
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