13-1618 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application. valuation:
Applicant:
13-00001618
78275 WINNIE WY
770-3,40-012- - -
PATIO COVER - RESIDENTIAL
LOW DENSITY RESIDENTIAL
35000.
Titit 4. VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT ^� INSPECTIONS (760) 777-7153
BUILDING PERMIT `
Date: 2/14/14
Architect or Engineer:
�atMR�e.It• - ' �.
Owner:
MARK KIESEL
78275 WINNIE WAY
LA QUINTA, CA 92253
(760)321-2300
Contractor:
RAM DEVELOPMENT & CONST CO
72218 DESERT DRIVE
RANCHO MIRAGE, CA 92270
(760)321-2300
.T M- C' ne'9L _
kCFEB14 2014
C11Y OF LA QUINTA
FINANCE DEPT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ - - - - - - - - - - - - - - -.- - - -
LICENSED CONTRACTOR'S. DECLARATION
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penalty of perjuri tha I am licensed under provisions of Chapter 9 (commencing with -
I hereby affirm under penalty of perjury one of the following declarations:
Section 000)
f Division 3 of t _EanOfLSsis Codeand myLicense is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License lass:
B Lice No.:529976
16r by Section 3700 of the Labor Code, for the performance of the work for which this permit isissued.
Dat I 7
Contrac
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
NER-BU DECLARATION
insurance carrier and'policy number are:
I hereby affirm under penalty o
�rom the Contractor's State License Law for the
Carrier 14EFFERNAN INSUR Policy Number 90403222013
following reason (Sec. 7031 :5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performa ce of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manners eee 'act to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I sh bject to t rkers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or -
3700 of the La or Cod I shall r ith comply wit o kAl2Qs. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by�''--
I
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1
Da
1 Applicant:
(_) 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
WARNING: FAILURE TOSEC E ORKE S' COMPEN COVE GE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT ANEMPLOYERTO I AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000).. IN ADDIT ON TO T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within -
SECTION 3706 OF THE LABOR CODE, EREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. .
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
f whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P,C. for this reason
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. -
Date: Owner: -
2. Any permit issued as a result of this application becomes null and void if work is not commenced
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:
LQPERMIT
within 180 days from date of issuJofsuermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and stais correct. I agree to comply with all
city and county ordinances and state laws relattr ion, an y authorize representativesof this unty o enter upon the above-mentionin ion purpo(Date Signature(Applicant or Ag
Application Number . . . . . 13-00001618
Permit PATIO COVER 2013
Additional desc .
Permit Fee . . . . 131.5'6 Plan Check Fee
.00
Issue Date Valuation . . .
. 35000
Expiration Date 8/13/14
Qty Unit Charge Per
Extension' .
1.00 131.5600 EA MISC PATIO COVER, SPEC
-------------------------------------------------------------------------------
131.56
PermitELECTRICAL 2013 .
Additional desc .
Permit Fee 23.83 Plan Check Fee..
.00
Issue Date . . . Valuation
0
Expiration Date 8/13/14
Qty Unit Charge .Per
Extension
1.00 23.8300 LS ELEC FIXTURES,. FIRST 20
- --------------------------------------------------
23.83
Permit MECHANICAL 2013
Additional desc .
Permit Fee, 143.00 Plan Check Fee
.00
Issue Date 1/15/14 Valuation . . .
. 0
Expiration Date 7/14/14
Qty Unit Charge Per
Extension
4.00 35.7500 EA MECH OTHER EQUIP
-------------------------------------------------------------------------
143.00
Permit PLUMBING 2013
Additional desc .
Permit Fee . . . . 23.84 Plan Check Fee
.00
Issue Date . . . . Valuation
A
Expiration Date 8/13/14
Qty. Unit Charge Per
Extension
2.00 11.9200 EA PLBG ROOF DRAIN
23.84
- --------------------------------
Special Notes and Comments
NEW 568 SQ. FT. CUSTOM PATIO TRELLIS
WITH SOLID ROOF.
January 15, 2014 7:38:15 AM jjohnson.
------------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, PATIO COVER
165.88'
PLAN CHECK, ELECTRICAL
23.83
LQPERMIT - -
-
Application Number
. . . . .
13-00001618
------------------------------------------------------------------
Other Fees
PLAN CHECK,
MECHANICAL.
-
143.00
PLAN CHECK,
PLUMBING
23.84,. K
STRONG MOTION (SMI) - RES
3.50
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
-----
322.23
----------
.00
---------- ----------
.00
322.23
Plan Check Total ',-
.00•
.00
.00
.00
'Other Fee Total
361.05
.00
.00
361.05
Grand Total
r
683.28
.00
.00
683.28 ,