04-4871 (PAT)BUILDING & SAFETY DEPARTMENT
P -O. Box 1504 (760).777-701.2
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7153
s
BUILDING PERMIT
Application Number . . . . .
04-00004871 Date
6/10/04
Property Address . . . . . .
79816 DECLARATION CT
APN:
604-511-017-24 -24197 -
Application description . . .
PATIO COVER - RESIDENTIAL
_Property Zoning . . . . . . .
LOW DENSITY RESIDENTIAL
Application valuation . . . .
4708
Owner
Contractor
- ------ - - - - - - - - --- - - - - - --
PALMER GEORGE C
------------------------
C4 PELLETIER CONSTRUCTION
-NQ:;_Qu P -?!f - /(0
74691 SWEET WELL ROAD
bliftNOT'N CA -997n
THOUSAND PALMS
CA 922.76
C�(a gZZ53
(760) 275-60`17
WCC: STATE FUND
WC: 54952004
01/01/05
CSLB: 260484
12/31/04
CCC': 81
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Permit . . . . . . PATIO -COVER PERMIT
Additional desc .
Permit Fee 72.00
Plan Check Fee
46.80
Issue Date
Valuation
.4708
Qty Unit Charge Per
Extension.
BASE
FEE
45'. 00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
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Special Notes and Comments
354 S.F. ALUMAWOOD.LATTICE PATIO
COVER
Other Fees .. . . . . .
STRONG MOTION (SMI) - RES
.50
Fee summary —Charged
Paid Credited
Due
Permit Fee Total 72.00
.00 .0'0
72.00
Plan Check Total 46.80
.00 .00
46.80
Other Fee Total .50
.00 .00
.50
Grand Total 119.30
.00 .00
1,19.30
� JUN l u 264
L,A QUINTA
P.O. Box 1.500_;
._
a VOICE (760) ,,_701:
78-493 CALLE TAMPICO FAX (760) 701 -
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-715.:
BUILDING & SAFETY DEPARTMENT
Application Number:. d Z4 811 Date: to ' t7
Applicant:
Applicant's Mailing Address:
Architect, or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I .hereby affirm under penalty of pequry'that Lam licensed under provisions of Chapter 9 (commit" with Section 7000) of Diviskon'3 of oro Business and, Professorial$
Code. and myLice ns in full tori a and effect � � `�JL
/License Class r license No.
0 avlo•s
owNER4UII-DER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any
city or county that requires a'permit to construct. Biter, improve. demolish. or repair any strimmi priorto its issuance. also requires the applicant for the permit touts a signet
statement that he or she is licensed pursuant to the provisions of the Contractors' 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 811eged;exempti0n. Any violation of Section 7031.5'by any applicant7dr a permit su(fjscts
the applicant to a civil penalty of not more than five hundred dollars.(S500).):.
U t,,as owner of the property. ormy employees with wages as their sole compensation, will do the work, and the structure is notintended or offered for tali (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not.apply to an owner of property who builds or approves thereon. and who does the Morn
himself or herself W through his or her own employees.,provpded thatths improvements are not intended or offered for sale. tL however. the budding or improvement is
sold within one year of compietion, the owner -builder will have the burden of proving that he or she did not build ouimprove forthe purpose of a".).
U 1, as owner of the property.•am exclusively contracting with licensed contractors to construct ft project (Sec. 70". Business and Professions Code: The ContreetorV
StateLicense Law does,not apply. to an owner'of property who builds or improves themon.:and who contracts for the projects with a'contraaor(s) licensed pursuant to
the Contractors' State License,Law.).
U i am exempt under Sec. . BA VC. for this reason
Date • .Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4risure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work.for which this pemrd is issued;
1 have and willhmainlain.workers! compensabowinsurance, as required by Section 3700,of the Labor Code, for the performance o1 the work for which this psmvt'is
issued. My ars' m ensation, ce carierrand pojiCy
_ I certify that, in the performance of the work for which this permit is issued. 1 shall not employ any person in any -mariner so as to become subject to the workers'
compensation laws of California. and agree that, if should become subject to theeworkers' tompensetion provisions of Section 3700 of the Labor Code. I shall
foitMvilh;oomply with thoZK
Date to Lr o lug I
WARNING: FAILURE:TO SECURE WENSATION COVERAWIS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED TLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR 1N
SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
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
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 set forth an this application.
1.. Each person upon whose behaff'ihis application is made, each person at whose,request and for whose benefit work is performed under or Pursuant to any psnnit
issued as a result of this application. the owner, and the applicant, each agrees toi and shall, defend. indemnify and hold harmless the City of Lo Ouinta; tb
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
Z Any permit issued as a resusa thisapptication becomes null and void d work'is not . cad within 180 doyr from date of issuance of wch Pat. m! or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this appticatiori and.state that the attove ' n iwooneet 1 to y with all ah and county ordinances and state laws raf♦4np to buildhap
konsbuction. and hereby authorize representefves a this to.enter a 7 for'inspection purposes.
(, 10/p..l / /1
--// l (APPlisxr►t or Agent � 1
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 1 '/,0. -OY5�_
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