04-5756 (PAT)Taf °F 4Qxwdj
P.O. Box 1504
78-495 CALLE TAMPIco
LA QUI -NTA, CALIFORNIA 9225,3
Application Number
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777=7012
FAX. (760) 777-7011
INSPECTION REQUESTS (760) 777-7153-
. 04-00005756 Date 7/28/04
. . . 79774 DECLARATION CT
6041-51.1-020-27 -24197 -
. . . PATIO COVER - RESIDENTIAL
. . . PARKS & RECREATION
. . . 2660'
Owner
----------------------
BROWNE PETER J-
79774 DECLARATION COURT
LA.QUINTA CA 92253
Contractor
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HOFFNER CONSTRUCTION, FLOYD M.
44-489 TOWNCENTER WAY D-15:3
PALM DESERT CA 92260
p /k --1j
JUL 2 8 2004
CIN OF LA QUINTA
FINANCE DEPT.---
WCC:
STATE FUND
WC:
0025242
08/01/04
CSLB:
44145.6
06/30/08
CCC:
B
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Permit . . . .
. P.ATIO COVER
PERMIT
Additional desc
Permit Feer
.. 5.4.00
Plan
Check Fee
35.10
Issue Date . . .
.
Valuation
. . . .
2660
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
1.00 5.000G
THOU BLDG
2,'0,01-25,000
9.00
Special Notes. and
Comments
200 SF ALUMAOOD
PATIO COVER IN'REAR
YARD. 2001 CBC.
Other Fees
.. STRONG MOTION
(SMI) - RES
.50
Fee summary
Charged
Paid Credited
Due
Permit FeeTot_al
54.00
.00
.00
54.00
Plan Check Total
35.10
.00
..00
35.1:0
.Other Fee Total
.50
.00
.00
.50
Grand Total
89.60
.00
.00
89.60
p /k --1j
JUL 2 8 2004
CIN OF LA QUINTA
FINANCE DEPT.---
P.O. Box 1.504 af 4 # Q"4%r#j VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 9.2253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:wW:7��
6
Applicant's iMalling Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.,
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
Thereby affirm underpenalty•ot perjury that:l am licensed under provisions of Chapter 9 (commencing with'Section 7000) of'Division 3 of the Business and Professionals
Code; and, my LicensWin full force and effect. c
License Claws S Li se No. y 7"
Da*tej'l 0 Contracto in{NL `
t AV
OWNER43UILDER DECLARATION
I herebyaffirn.under penalty of perjury that I am exempt from the Contractors' State License Law forthe 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 stricture, prior to its Issuance, also requires the applicant for the permit to:file a signed
statement that he or sheds licensed pursuant to the provisions of the Contractors' State License.Law (Chapterg (commencing with Section 7000) of Division 3 of ft Business
and Professions Code) or that'he or she is,exempt therefrom and the basis for the alleged exemption: Any violatlon of Section 7031.5 by any applicantfor a permit subjects
the applicant to a civil penaityof,not more thamfive•hundred dollars ($500).):
U 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 (Seo. 7044,
Business and Professions Code: The Contractors'` State License Law does not apply to an owner of property who'builds or Improvewthereon, and who does the work
himself, or herself or through; his or her own employees, i provided that the Improvements are not Intended or offered for seta: If, however,.the building or improvement is
sold Within one year of completion, the.owrier-builder will have the burden of proving that he or she did not build or improve forthe purpose of sale.).
U 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 propertywho.builds or improves thereon, and who contracts for the projects with a contractors) Incensed' pursuant to
the"Contractors'"State License Law,):
U I am exemptunder Sec. BA P.C..for this.reason
Date Owner
WORKERS' COMPENSATION;DECLARATION
I'hereby affirm under penalty of pequryone of the following declarations:
_d. have and will maintain,a certificate ofconsent.to self -insure forworkers' compensation, as provided for by Section 3700,of the Labor Code, for the performance
of the workforwhich this permit is issued.
_ I haveand will;maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this pemdt'ts
issued. workers' compensation, insurance carrier an' j pQl� rwmber alq;
Cartier ��a 4L2 Policy Number
_ I certify that, In'he performance of the work for which this permhlls issued, I shall'not'employ any person in any manner so as to become subject to.the workers'
compensation laws ofCalifomia, and agree that; it I should come subject to the workers' compensation provisions'ofSection 3700 of the Labor Code;,I shall
forthwith comply with. those:provislons
WARNING: FAILURETO SECURE WORKERS' COMPENSATION`COVERAGE 1S UNLAWFUL, AND -SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND
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.
CONSTRUCTION LENDING: AGENCY'
1 herebyatfirm under perieRyof perjury that there is a construction lending agency for the performance of the work•for which:this permit is issued (Sec. 3097,1Civ. C.).
Lenders Name
Lenders Address.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director. of Building and Safety for a permit subject to�the conditions and restrictions setforth on this.applicalion.
1. Each person upon whose behalf this application is made, each person at whose requestand 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 oulnta; its
officers, agents and employees foranyact or omission reiated•to the work•being,perfomred under or following issuance of thispsrmiL
2. Any permit issued as a result of-this,application becomes null -and void ifwork is not commenced wiihin 1110 days from date of'issuance of such permit; or
cessation of work4br 180 days will subject permit to cancellation..
i.certify that I have read this application and state thatthe..above information .correct. I.agree to comply with all city and county:ordinancss and state laws relating to'building.
construction, andCh�ereby authorize representatives of this county to enter u n fhe>a ntkned property for inspection purposes:
Date CJ \ Signaturw(Appiicant or Agent): i
C
P
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SITUS ADDRESS 77 Y ------------
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RE-INSPE
TION FEE OF $30 'JUICE BE CHAR MED IF THE APPROVED
PLANS AND I ( 1 6 CARD ARE NOT ON
THE SITE FDR A SCHEDULED
INSPECTION.
NO CEPTIONS'
DATE BY��
C*
60
-SO
G
lid,
RE-INSPE
TION FEE OF $30 'JUICE BE CHAR MED IF THE APPROVED
PLANS AND I ( 1 6 CARD ARE NOT ON
THE SITE FDR A SCHEDULED
INSPECTION.
NO CEPTIONS'