BPAT2017-001378-495 CALLE TAMPICO DVOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/10/2017
Application Number: BPAT2017-0013 Owner:
Property Address: 79878 WILLIAM STONE WAY JEFF BLACKLEY
APN: 604492003 79878 WILLIAM STONE WY z
Application Description: BLACKLEY / 540SQ FT PATIO COVER AT BACKYARD LA QUINTA, CA 92253 z
Property Zoning:
Application Valuation: $1,680.00 0 ca
C3
Applicant: Contractor: ) g o
C & S PATIO COVERS C & S PATIO COVERS
65269 ELAINE CIRCLE 65269 ELAINE CIRCLE Q
MECCA, CA 92254 MECCA, CA 92254
s
(760)625-4225
Llc. No.: 1004320
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penalty of perjury that I am licensed under provisions of Chapter 9.
1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and
_ I have and will maintain a certificate of consent to self -insure for workers'
my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: D03 License No.: 1004320
of th�ey� rk for which this permit is issued.
'Y� ' have and will maintain workers' compensation insurance, as required by
Date: O E ontractor: --
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:
OWNER -BUILDER DECLARATION
Carrier.,; NORGUARD INSURANCE COMPANY Policy Number: CSWC791810
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
'certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
em
shall not ploy any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Co , I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
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
Date: /�0 0 Applicant
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
_ _--- ��1
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(_) I, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
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
Date: Owner:
for 180 days will subject permit to cancellation.
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
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: o f '�- Fgnature (Applicant or Agent
—� r
Application Number:
BPAT2017-0013
Pta�Addr�ss:' ":u?49878
WILLIAM STONE WAY
APN:
604492003
Application Description:
BLACKLEY / 540SQ FT PATIO COVER AT BACKYARD
Property Zoning:
Application Valuation:
$1,680.00
Applicant:
C & S PATIO COVERS
65269 ELAINE CIRCLE
MECCA, CA 92254
Owner:
JEFF BLACKLEY
79878 W LLIAM STONE WY
LA QUINTA, CA 92253
Contractor:
C & S PATIO COVERS
65269 ELAINE CIRCLE
MECCA, CA 92254
(760)625-4225
Llc. No.: _004320
Date: 3/10/2017
Detail: 540SQ FT SOLID PATIO COVER WITH (2)FANS AND (8) LED RECESSED LIGHTS, ON EXISTING CIRCUIT, WITH MOTION/PHOTO CONTROL OR THE
LIKE, AT REAR YARD [DURALUM] 2016 CALIFORNIA BUILDING CODES.
FINANCIAL •• •
..DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid foi ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN
101-0000-42404
0
$101.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN PC
101-0000-42600
0
$100.32
Total Paid for PATIO COVER / COVERED PORCH / LATTICE: .$202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENITATION SMI: $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
Qty of L a Qullita
Building Sz Safety Division
P rmit #I . - 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701;2
I Building Permit Application and Tracking Sheet
Project Address: 7878 ��'U Owncr's Name:'
A. P. Number: (�
Address: 8 7 1 nip,,J '
Legal Description:
City, ST, Zip: L
Contractor:
s
TelePh ne:(oD
766 61Y2
..:.
Address: 2 6f
Project Description: Q
60 12a746'
City- ST, Zip:
r7i
Tele 3, ne
P 0 .7 Z u.
7 5
r r
6 ,OL
State Lic. # Ar 4�-o
1 City Lie.
Arch., Engr., Designer:
Address:
61
City, ST, Zip:
r
Telephone: one:
n tructi n Type: C
:Co
ecu aneY
State a L �.
t ic. •
Project type (circle ne • New Addn Alter Repair Demo
0
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Verson
Plan Check Balance.
f
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Revicw, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
M.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.I'.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permil Fees
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ING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR. CONSTRUCTION
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