04-4872 (PAT)r-'
BUILDING & SAFETY DEPARTMENT
P.O. Box 150.4 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-701.1
-LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . 04-00004.872 Date 6/10/04
Property Address . . . 45345.DEERBROOK CIR
APN: •60.4-404-007-26 -239.95 -
Application description . . . PATIO COVER - RESIDENTIAL
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
.Application valuation . . . . 4788
Owner Contractor
BECKER MARK PELLETIER CONSTRUCTION
-45345 DEERBROOK CIR 74691 SWEET WELL ROAD
LA QUINTA CA 92253 THOUSAND PALMS CA 92276
(760) 275-6017
WCC: STATE FUND
WC: 54952.004 01/01/05
CSLB: 260484. 1.2/31/04
CCC: B1
Permit . . . . . .PATIO COVER PERMIT
Additional desc .
Permit Fee 72.00 Plan Check Fee 46.80'
Issue Date . . . . Valuation .47.88
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG.2,-001-2.5,OOD 27..00
Special. Notes and .Comments
360 S.F. ALUMAWOOD•LATTICE PATIO COVER
--------------------------------------------------------------------------------
Other Fees . . . . . . . . . STRONG MOTION (SMI)' - RES .50
Fee summary
------------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid Credited Due.
72.00 .00 .00 72.00'
46.80 .00 .00 46.80
.50 .00 '.s0,0 .50
119.30 .00 .00. 119.30
-
• Jl1N 1 Q 1CC4
CITY OF LA Qt�PFA
�Z
P.O. BOx 1504_ •4 VOICE (760) 777-701:.
78-495 CA LE TA'MPICO FAX ('760) 771- '0'1 i
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (76.0) 777-71,53
BUILDING & SAFETY DEPARTMENT
Application Number: 7 Date: (o' t o —U
Architect or Engineer:
Applicant:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter g (commencing wifh,Secion 7000) of Division 3 of this Susirisss:and Professionals
Code.. and my License is in full force, and a}fa
License Class License No
Date�+ l o U�►-'r Corttri
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 exempt from the Contractor' State License Law for the following reason (Sac. 7031.5, Business and ProMasions Code. Any
city or county that requires a pemdt to construct ,atter, improve, demolish. or row any structure; prior -to Its issuance, also requires the applicant for the permit to his a signed
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 on 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 No hundred dollars (SSW).)!
U I, as owner of the' property, or my employees with,wages as.then sole compensation. will do the -work. and the structure is not intended or offered.for sale (Sec. 7041,
Business and Professions Coder The Contractors"State License Law does not apply to an owner of property who builds or improves thereon. and who doss the work
himself or herself or through his or her own employees, provided that the improvements are not intended or oAered 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 On did not build or improve for the purpose of
(} I, as owner -of the (S
propeAy, am,exclusively contracting with licensed contractors to construct the Project Mac. 7044. Business and Professions Cods: This Contractors'
State License Law does notapply W an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant 10
the Contractors' State License Law;).
U I am exempt undersec. , 8.3 P.C. 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 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 wortkerV compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�+}}ssued. MY rke ompensation��'vs� nce comerana
_I Certify that, in the performance.of,thework, for which this permit is issued. l' II not employ any person in any Manner so,as'to become subject to to workers'
compensation laws of California, and agree that, ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code,1 shell
forthwith comply with tf�ns. �
` Date G j t o S d
WARNING: FAILURE TO SECURE *O*ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL:PENALTIES AND
CIVIL FINES UP TO.ONE HUNDRED"THOUSAND DOLLARS (St 00,000), 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
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.).
Lendeds Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fors permit subject to tie conditions and restrictions set forth on.Nus'apptieation.
1: Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pumuord to any penmit
issued as a result of this application. the owner.,and the applicant, each agrees to, and ahati, defend, indemnity and hold hsnniess the City of La OuirM , ib
officers, agents and employees for. any act or omission related to the work being performed under or following issuance of he permit:
2. Any pemdtissued as a. result of this, application, becomes null and void if work isnot cad within 180 days from:date of issuance of such pernM, or
cessation of work for 1110 days will subject permit to cancellation.
I certify,that 1 have read tt►is appticatioei and state that the above an is otxtetx I ap t0 y with all city and county ordinances and state lawsrelelbtp to buYdisip
construction. and hereby authorize to of oris to enter u the a tioned for inspection purposes.
Signature (Applicant orAgant)
0r-hcc co?
Cl`,7-Y OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONS
TRUCTION
DATE ' �� ! BY
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