05-0041 (PAT)Taf '. 4.604"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
tAN 5 2005
CITY OF LA QUIMTA
FINANCE DEPT.
Application Number . . . .
. 05-00000041 Date
1/05/05
Property Address . . . . .
. 450.35 DESERT FOX DR .
APN:
604-280-026-23 -23935 -
Application description . .
. PATIO COVER - RESIDENTIAL
Property Zoning . . . . . .
. LOW DENSITY RESIDENTIAL
Application valuation
5998
.Owner
Contractor
WESTERGREN KELLY B
PELLETIER CONSTRUCTION
45035 DESERT FOX DR
74691 SWEET WELL ROAD
LA QUINTA, CA 92253
THOUSAND PALMS, CA 92276
(760)275-6017
WCC: MONUMENT AGENCY
WC: WC050104010001
05/01/05
CSLB: 260484
12/31/06
----------------------------------------------------------------------------
CCC: B1
tAN 5 2005
CITY OF LA QUIMTA
FINANCE DEPT.
P.O. BOX 1504• agwai
V610E (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: o / Date: %
Applicant: C _
Applicant's 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 perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
e, �d my L'Mss in full force and effect.
Li nse-Ctass - L7 rEIM g -No
OWNER43UILDER 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, 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 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 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).):
U 1, 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 or through his or her own employees, provided that the improvements are not intended or offered for sale. It. 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.).
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 property who builds or improves thereon, and who contracts for the projects with a contraclor(s) licensed pursuant to
the Contractors' State License Law.).
(_.) 1 am exempt under Sec. , BA P.C. for this reason
Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
_ 1 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. WworkeX compensation !Qsurance ca rier and policy number
compensation laws of Calif(
forthwith comply with those
os—
Number bk.0 OStJ t UL -C U ( Vv
red, I shall not employ any person in any manner so as to become subject to the worketV
subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
WARNING: FAILURE TO SECURE WORKS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIV& FINES UP TO ONE HUNDRED THOUSA DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES,AS PROVIDED FOR IN
SECTION 3700 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.).
Lenders Name
Lender's 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 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, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to the work being perf ed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is com nced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject pernit.to cancellation.
1 certify that I have read this application and state that theve info tion is correct I a ree to co ply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of thi county to ent r upm the above ntion property for inspection purposes.
/V
----------------------------------------------------------------------------
•:Application Number . . . . . 05-00000041
----------------------------------------------------------------------------
Permit . . . . .
. PATIO COVER
PERMIT
Additional desc .
.
Permit Fee . . .
. 81.00
Plan Check
Fee
52.65
Issue Date . . .
.
Valuation
. . .
.
5998
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
4.00 9.0000
THOU BLDG
2,001-25,000
36.00
----------------------------------------------------------------------------
Special Notes and
Comments.
451 SF ALUMAWOOD
PATIO COVER
Fee summary
-----------------
Charged
--------------------
Paid Credited
----------
----------
Due
Permit Fee Total
81.00
.00
.00
81.00
Plan Check Total
52.65
.00
.00
52.65
Grand Total
133.65
.00
.00
133.65
. .� 1A y, •, ,�.,.
ji
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE L -� —
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPTIONS!
�CeI c1 4 t1e itt2a We5+crgmn
-IS03S C)e5evl t=ox lec(•
ca
1112 2 53
rouse
41 G,=
A1 u v o,wo� Sv l; S Pcaitc,
co %., e,.-
c -,,o w +Ck
12 C,c7h$z�c,� i no GC_k-JA- I
�►w�-