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05-2062 (PAT)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00002062 Property Address: APN: 45275 DESERT AIR ST Application description: 604-331-004-2 -23935 - Property Zoning: PATIO COVER - RESIDENTIAL Application valuation: LOW DENSIT Tiht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: --------------------------------- CARLOS CARRILLO 45275 DESERT AIR ST LA QUINTA, CA 92253 Date: 5/27/05 r p Contractor:-. Applicant: Architect orE er. --------------------------------- PELLETIER CONSTRUCTION MAY 2 7 1p0�]] 74691 SWEET WELL ROAD \f� [ THOUSAND PALMS, CA 92276 �J CITY OF LAQU�NTA fp Lic. No.: 5495 FINANCE DEPT. ---------------.----------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty ofp ry that licensed under provisions of Chapter 9 (commencing with section 7000) of Division 3 of a Business and fessionals d my License is in full force and effect. License Class: 260484 cense No. 5495 �te: �Z �D) ontra or: OWNER -BUILDER DECLARATION I hereby affirm under penalty o erjury t t I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Bu" ass 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).: (_ 1 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.). (_ 1 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 property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). I—) I am exempt under Sec. , BAP.C. for this reason Date: Owner: 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: Lender's Address: 0 /[A LQPERMIT 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. V-1 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 7593 -------- PolisttNumber STATE FUND certify that, in the rformance of the w person in an anner s0 as to become and agree t at, if I should become subj 3700 oft a Labor Code, I shill forthw 7 S 14-7 0 cant: 7 - Suetl, I shall not employ any workers' comp nsation laws of California, vers' compensa ion provisions of Section with those WARNING: FAILURE TOS URE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CR44LNAL_BENALTIES AND 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. 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 thiappLigaition becomes null and void if work is not commenced within 180 days from date suar of su ermit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this applicati and state that the above 'nformati n is correct. agree to comply with all city and county ordinances ands to aws relating t ding con tructio and hereby thorize representatives of this coynt7o entevupon abov -mentioned ope far i ction p rposes. Date: _ _z �)( ignature (Applic t or Ag t): Application Number . . . . 05-00002062 Permit . . . PATIO COVER PERMIT Additional desc . . Permit Fee . . . . 72.00 Plan Check Fee 46.80 Issue Date . . . . Valuation . . . . 4495 Expiration Date 11/23/05 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 27.00 ---------------------------•------------------------------------------------- Special Notes and Comments 338 S.F. ALUMAWOOD PATIO COVER, PER APPROVED PLANS _ ---------------------------------------------------------------------------- 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 LQPERMIT 15� Cs flos (-45- Q -7S Si—. C/4 CRe�� f c-,im co v ev CITY LA QUINTA BUILDINC & SAFETY DEPT. APPROVED FOR C NSTRUCTION 3I - cola\r: lin�v�ve jr . cPVnvete ,SRWNSPECTION FEE HE OF WILL BE CHARGED IF D ARE NOT ON PLANS AND JOB CA THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS!