05-4272 (PAT)P.O. BOX 1504
Owner:
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
78512 NAPLES DR
!Application Number:
,0,5-00004272
Property Address:
57595 SOUTH—VALLEY LN
APN:
762-250-009- - -
Application description:
PATIO COVER - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3591
Applicant: Architect or Engineer
LICENSED CONTRACTOR'S DECLARATION
4 XP
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT -
VOICE (760) 777-7012
FAX (760) .777-7011
INSPECTIONS (760) 777-7153
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:
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 ($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 Licens Law does not apply to an owner of
property who builds or improves thereon, and who contracts for th ojects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
I hereby affirm under penalty of perjury that then
work for which this permit is issued (Sec. 309f,
Lender's Name:
Lender's Address:-
LQkRAIIT
agency for the performance of the
Date: .10/27/05
-----------------------------------------------
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
insurance carrier and policy number are:
Carrier, Policy Numb
orw er
• _ I certify that, in the performance of the wk for this permit is issued, I shall not employ any
person in any manner so as to become subje o e w rs' compensation laws of California,
and agree that, if I should become subject rs' compensation provisions of Section
3700 of the Labor Code, I shall forthw' ith those provisions. -
WARNING: FAILURE TO SECURE WOKERS' C PENS ON COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE IES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS 100,0001. IN ADDITION T ECO COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERES ND 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 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information i o ect. I. gree to comply with all
city and county ordinances and state laws relating to building construction d ere uthorize representatives
of this county to enter upon the above-mentioned property for igspecti
(Applicant or Agent):
Owner:
GEYER DOUGLAS L
78512 NAPLES DR
DLA
QUINTA, CA 92253
OCT 2 8 2005
Contractor:
CITY OF LA GIUINTA .
Owner
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:
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 ($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 Licens Law does not apply to an owner of
property who builds or improves thereon, and who contracts for th ojects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
I hereby affirm under penalty of perjury that then
work for which this permit is issued (Sec. 309f,
Lender's Name:
Lender's Address:-
LQkRAIIT
agency for the performance of the
Date: .10/27/05
-----------------------------------------------
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
insurance carrier and policy number are:
Carrier, Policy Numb
orw er
• _ I certify that, in the performance of the wk for this permit is issued, I shall not employ any
person in any manner so as to become subje o e w rs' compensation laws of California,
and agree that, if I should become subject rs' compensation provisions of Section
3700 of the Labor Code, I shall forthw' ith those provisions. -
WARNING: FAILURE TO SECURE WOKERS' C PENS ON COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE IES CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS 100,0001. IN ADDITION T ECO COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERES ND 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 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information i o ect. I. gree to comply with all
city and county ordinances and state laws relating to building construction d ere uthorize representatives
of this county to enter upon the above-mentioned property for igspecti
(Applicant or Agent):
Application Number . . . . 05-00004272
Permit . . . PATIO COVER
PERMIT
Additional desc .
Permit Fee 63.00
Plan Check Fee
40.95
Issue Date . . . .
Valuation
_3591
Expiration Date 4/25/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
Special Notes and Comments
patio 270 sq. ft.October'27, 2005
3:03:59 PM jjohnson
------------------------------------------------------------=---------------
Other Fees . . . . .'. . . . 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 .50
.00 .00
.50
Grand Total 104.45
.00 .00
104.45
LQPERMIT
'Bin #
Cit La of Quinta
Building_a-Safety Division---......- --„---- ,.._,.. -------------- -
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Permit #
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P.O. Box -1504; 78-495 Calle Tampico
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La Quinta, CA 92253 = (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
A. P. Number:
Address: —7 ` LN
Legal Description:
City, ST, Zip:
N
Contractor: �w� ��,
Telephone:
I ' KhSYCD.�'
Address:
Project Description:
City, ST, Zip:
Telephone:
State
State Lic. # : City Lic. #:
Arch., Engr., Designe r
Address:
City, ST, Zip: r27
c) = 270
Telephone: � .. �• �,. __
Construction Type: Occupancy:
State Lic. #: c t ”
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person ` 6,
Sq. Ft.:
# Stories:
# Uriits:
Telephone # of Contact Person! I � j74 -862•(p Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING . PERMIT FEES
Plan Sets
Plan Check submitted 9 tem
Amount
ZStructural
Calcs.
Reviewed, ready fo correctio Plan Check Deposit
low
Truss Calcs.
Called Contact Plan Check Balance
Energy Cates.
Plans picked up 60/ Construction
Flood plain plan
Plans resubmitted—
Mechanical
"
+C
Grading plan
2"" Review, ready for correction /issue O Electrical
`
Subcontactor List
Called Contact Person Plumbing
Grant DeedPlans
picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading,
IN HOUSE:-
1rd Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person 4 I p p
Pub. Wks. Appr
Date of permit issue
School Fees
y un.,f�
Total Permit Fees
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YOUNGENGINEERING' SERVICES
•Engineering '•Architecture•Surveying• Building & Safety Services
• Letter of Transmittal
' To: City of La Cuinta+
Date: 10/20/05 + ,
Project: 57-595 South Valley Lane,
•
Attn: Ed Randall PCk 05-4272(2 . na) -
Tel No.: (760) 777-7012 Tract No.: "
We are forwarding: • X By Messenger By Mail Your Pickup
No: of Copies Description:
' 1 Revised Plans
Revised Struct
1 Redlined Plans
1 Revised Struct
F •
• , e r
Comments: Structural contents are approvable '
Thank You. '
This Material Sent for: '
Your Fil6s Per Your Request
Your Review x Approval ,
• 'Checking At the request of: '
Other
'By: NCa-)lin P@chunuri
Phone # (760) 360-5770 EXT: 104 ,
•
77-804 Wildcat Drive, Suite C, Palm Desert, -CA 92211 (760) 360-5770
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