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04-5850 (PAT)w P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number . . . . . Property Address . . . . APN: Application description . . . Property Zoning . . . . . . Application valuation . . . . Owner SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE AZ 85258 BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00005850 Date 8/04/04 60279 DESERT SHADOWS DR 764-270-999-51 -300232- PATIO COVER - RESIDENTIAL MEDIUM HIGH DENSITY RES 5972 Contractor ---------------- PELLETIER CONSTRUCTION 74691 SWEET WELL ROAD THOUSAND PALMS CA 92276 (760) 275-6017 WCC: STATE FUND WC: 54952004 01/01/05 CSLB: 260484 12/31/04 CCC: B1 ---------------------------------- : . . . . . PATIO COVER PERMIT Additional desc.. Permit Fee . . . . 81.00 Plan Check Fee 52.65 Issue Date . . . . Valuation . . . . 5972 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 ALUMAWOOD LATTICE PA"O COVER 449 SQFT. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES .59 Fee summary Charged Paid Credited Due ------------------------------------------------------- Permit Fee Total 81.00 .000© 81.00 Plan Check Total 52.65 .00 X00 52.65 Other Fee Total .59 .00 o O,�Qw 59 Grand Total 134.24 00 r 030 `��p 4 .24 P.O. Box 1504 •4 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: 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 Code, and my. License is i II force and effect. License Class 1�, } _ License No: 'Date—iJ1L=1'r & 4 Contractor lX�f'Y OWNER -BUILDER 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 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 or 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.). 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 contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date 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-My w rkers' pensation insurance carrier and olicy number, a: Carver Policy Number— certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo d agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with tho provision . lo. �_ Date t (0� f ApplicaURKERS' — — WARNING: FAILURE TO SECUREOMPENSATION COVERAGE IS UNLAWFUL, ANDSHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDOLLARS ($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 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 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 this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permoinformation I certify that I have read this application and state that the arect. I agree to co r 'a and county ordinances and state laws relating to building �—constiaction, and hereby authorize representatives df this ca above-mentio property for in pection purposes. D� ate —6)tel � O Signature(ApplicantorAgent i L CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® FOR CONSTRUCTI N DATE BY 44e,rm'i nacG, e z. t,-� ca cc2a 5 3 a' u folor, bmexrt mac+ F i