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12-0261 (PAT)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/10/12 Application Number: 12-0 000 02 61 Owner: Property Address: 80250 HERMITAGE TREASURE WEST APN: 762-230-026- - - Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3525 D d Contractor: ��� Applicant: Architect or Engineer: EDWARDS CONSTRUCTION INC, OB 51455 DESERT CLUB DRIVE N LA QUINTA, CA 92253 C11*y (760).777-8202 FINgbC Q(llld�q Lic. No.: 684857 �0FPr --------------------------------------------------- ------------------------------------ • LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of per' y that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section Too f Division 3 of the u ness rid Pr s n Code, and my Li , rise is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License ass: B icense No.: 68 ,857 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 13 T issued. Date: ontractor: 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier GRANITE STATE Policy Number WC1914223 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the perform r of the work for hich 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 manner so as o bec su • ct he workers' compe ation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State /1 and agree that, if I s ould come u j t to t orkers' compensa on provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or / � 00 of the Labor e;' f rt i y ith those provi ' s. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by fH�.// / any applicant for a permit subjects the applicant to a civil penalty of not more than five hundied dollars ($500).: ate. pplicant: (/ (_ 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 WARNING: FA URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 ADDITION TO THE 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, INTEREST, 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.). (_) 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 hot 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 am exempt under Sec. , B.&P.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: LQPERMIT 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 permit to cancellation. I certify that 1 have read this application and state that the o e inf r tioh i aro rect. I agree to comply with all city and co my rdmances and state laws relating to ' ing ons u ion, h� reby authorize representatives of th' co ty tenter upo a above-mentioned pro e f r ins c pur os s. of 1' /y!V ,/ i Date: ` /� /� nature (Applicant or Agent): LQPERMIT Application Number . . . . . 12-00000261 ------ Structure Information 265SF TRELLIS COVER AT REAR PATIO ----- Permit . . . PATIO COVER PERMIT Additional desc _ Permit Fee 63:00 Plan Check Fee 40.95 Issue Date Valuation . . . . 3525 Expiration Date 10/07/12 - Qty Unit Charge Per Extension - BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special Notes and Comments 265SF TRELLIS`PATIO COVER AT REAR YARD (ENGINEERED] THIS PERMIT DOES NOT INCLUDE ELECTRICAL INSTALLATIONS._ 2010 CALIFORNIA BUILDING CODES. April 10, 20128:21:51 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 63.00 .00 .00 63.00 Plan Check Total 40.95 .00 .00 40.95 Other Fee Total 1.50 .00 .00 1.50 Grand Total 105.45 .00 .00 105.45 LQPERMIT Bin # *� l City of la Quints Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address:�i � Owner's Name: o `1 �y�!� 4 A. P. Number: /6Z 3 s�% �� Address: Q `2 9-0 � ,I Legal Description: �rOT �� p, !? City, ST, Zip: Contractor: hone: Address:1c;-1 -� �� '� Project Description: City, ST, Zip:.-� ..Telephone: "777 q,-> State Lie. # : 5-7 City Lia esigner: Address:,-? 7-6 Z , c:ic ,i TPt r[„�,' City, ST, Zip: Telephone: State Lie. iilhR4Y Name of Contact Person: ConstructioniYa Occupancy: Project type e): New Add'n Alter Repair Demo : # Stories: # Units: Sq. 11t., Telephone # of Contact Person: � �� � t� Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2. Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A.-Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for correctionsPissue Developer Impact Fee Planning Approval Called Contact PersonI.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Q J�o --� Om pie, 313oll 9 NA 4 lab �lei'L - lk�to�i't� 6SVJE Wb't : -StG►� db ?41-V. �"pWW4T W OM *W RAA ON rue)