04-4522 (PAT)s�. n
IBUILDING & SAFETY DEPARTMENT
AY �.. VoX.I IMJ4� (760) 777-7012
1,
C��►tOF- 78v -4 -9 -5 -CALLS M AMPICO FAX (760) 7774011
CITY 0IIN
�l19L`9uA CALIFORNIA 922.53 SPECTION REQUESTS (760) 777-7153
FIMANA� QU[;NTA,
BUILDING PERMIT
Application Number 04-00.004522 Date ,5/24/04
Property Address 54320 AVENIDA HERRERA .
APN:.. 774.-251-003.=22 -00000.0--
Application description .. PATIO COVER:- RESIDENTIAL
Property Zoning COVE RESIDENTIAL.
Application valuation 1676
Owner Contractor
DEAL PAULA !-PELLETIER CONSTRUCTION
54-320.AVE HERRERA 74691 SWEET WELL ROAD °
LA QUINTA.,.:. ..CA 92253 THOUSAND PALMS CA 92276
(760).275-6017
WCC': STATE FUND
WC: 5495200,4 01/01/05
..CSL!3 2.60484 12/31/04
CCC: Bl:
Permit ELEC-MISCELLANEOUS _ _ _-
-Additional desc .
Permit Fee- 15.75 Plan.Check Fee 3..94
Issue Date ... Valuation ., 0
Qty'., ..Unit.. Charge Per_:- _Ext_e_s-ion-----
BASE.FEE 15.00
T..00 .7500 PER ELEC DEVICE/FIX.TURE 1.8T 20 .75'
Permit . PATIO :CQVER PERMIT
Additional de'sc :..
'Permit Fee .. 391..00 Plan -Check Fee 2.5.35
Issue Date Valuation., 1676
"Qty Unit Charge Per' Extension
LASE FEE.. 15.00
1.2.00. 2.00p,O HND'. :BLDG 501-2,.000. 24.00
Special Notes and Comments
126..SQ FT ALUMAWOOD LATTIC PATIO COVER
Fee..summary Charged Paid Credited Due
Permit Fee Total 54.75 :00. 00 .54.75
Plan Check Total 29.29 .00 .00 '29.29
Grand Total .. 84.04 .00 .00 84.04
P.O. BOX 1504 VOICE {760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA Qu1r1TA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: — �f �n� off. Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
.Lic..No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1. am licensed under provisions of Chapter 9 (commencing with Serdion.7000) of Division 3 of the Business and PiVessionals
Code. and my Lice nsp is In full force a�deffect. O L(
License Class ifs LS 1 License No. (o L
Contractor
OWNER-BUILDEk DECLARATION
1 hereby ahfn, under penny of perjury that lam exempt from the Contractors' State License Law for the blowing (Sec. 7031.5. Business and Professions Code: Any
city or qty that requires a permit to construct alter, irnprove, demolish, or repair any structure. prior to its issuance, also requires the applicant for Me pemmit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter ti (commencing with Section 7000) of Division 3 of the Business
and Pto t:Ae-0r-she..ts-exempt4herefmm-and-the-basfsior alleged-emW6 .any appmam Im e pem. w subjects
the applicant to a civil penalty of not more than five twndred dollars ($500).):
U I. as owner of the property. or my employees with wages as Meir sole compensation, will do the work, and the structure Is not Intended or offered for sale (Sec. 7044.
Business and Professions Code: The Contiadors' 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. N. however, the build ng or improvement is
sold within one year of completion. the.owner-builder will have the burden of proving Cat he or she d'd not build or improve for the purpose of sale.).
L) 1. as owner of Me property. am exclusively contracting with lic n -contracts-b-c isbW:dw-project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply t4 an owner of property who builds or improves thereon. and who contacts for the projects with a contractor(s) licensed pursuant to
the Contractors' Slate License Law.).
i, I am exempt under Sec. B.3 P.C. for this'reason-. -
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ 1 have and will maintain a certificate of consent to self4 sure 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 Me Labor Code, for the performance of the work for which this permit is
issued. Myw�'ers' rtonmpensation insurance carrier and policy number are:
Carrier. �Jt�,t c F-�w—e Policy Number
_ I certify that In.the performance of the work for which this permit Is Issued, l shall not employ any person In any manner so as to become subject to the workers'
compensation laws of Calitomia, end ree that, it I should boa Io the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those p ns.a
Date `S 12- 11 �( Applicant .
WARNING: FAILURE TO SECURE WORK_ OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUS D DOLLARS ($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
1 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 _
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a pemdt 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 performed under or following issuance of this pernit.
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 perp' 11 U.
1 ceitiy.that 1 have read this application and state that hove in bon is correct. agree to y with all city and county ordinances and state laws relating, to building
constriction, and hereby authorize representatives of It
county to ter upon the ve men ' ed property for inspection purposes.
Date b�ZVf /Signature(Applicantor
r6C Ce
CITY OF LA QUANTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
b AT E ---X:
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54 32o Ave*%�,cic,
CA
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P.O. BOX 1504
Building �,� N ��r�r1 78-105 CALLE EST ADO
Addres S `� LA QUINTA, CALIFORNIA 92253
Own r
6V
Mailing
Address 12T, 27 9.5-
City
tSCity ^ • ,^ Zip
Contractor`V
C ,aw•-t
Address
City
Zip
Tel.
State Lic.
City
& Classif. Ll —7 ?J—'- —7
Lic. q
- Arch., Engr.,
Designer
Address
Tel.
City Zip State
Lic. q
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm thtl I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license Is In full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 (5500).
I'! 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees.
provided that such improvements are not intended or offered for sale. f, however, the building
or improvement is sold within one year of completion, the ownerbuilder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I i 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r7 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars (5100) valuation
at less.)
I 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 California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
FINANCE
IOU
APPLICATION ONLY
ILDING: TYPE CONST. OCC. GRP.
'. Number
Description
2,?f
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
do, hA