05-3673 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C05=00003_6.7,3_
Property Address: 485'57 VIA ENCAN_ TO
.APN: 646-091-002- - -
Application description: PATIO COVER - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4057
Applicant:
Tu4t 4 4a " .
BUILDING & SAFETY DEPARTMENT
Architect or Engineer
BUILDING PERMIT
PF AUG 1 9 2005
CIN OF LA QUINTA
FINANCE DEPT.
LICENSED CONTRACTOR'S DECLARATION - _
I hereby affirm under penalty of perjury ' ensed u r provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B loess and Pro ss' als ode, and my License is in full force and effect.
LicenseQQClass: B -C33 L' ense No.: 260484
Dater?` I0� (Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm underpenalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
1—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot 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 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.).
(_ 1 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 1 1 1 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 ISec. 3097, Civ. C.).
�_�) Lender's Name:
Lender's Address: '
LQPERMIT
Owner:
ERICKSON RONALD G
48557 VIA ENCANTO
LA QUINTA, CA 92253
(760) 27.5-7593
Contractor:
PELLETIER CONSTRUCTION
74691 SWEET WELL ROAD
THOUSAND PALMS, CA 92276
(.760)275-7593
Lic. No.: 260484
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/19/05
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty of perjury one of the following declarations:
I 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 workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 5495
I certify that, in theotbeco
a work for which this 's -issued, I shall not employ any
person in any meco subject to the orkers' c laws of California,
and agree that, ime subje to the wor ers' comp sation provisions of Section
3700 of the Laborthwit omply wit those pr isions.LOate: lej IUJ APPlicaot-WARNING: FAILURE TO SECURMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
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.
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 behalfthis 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 v ' rk is not commenced
within 180 days from date of issuance of such permit, or cessa on of work or 180 days will subject
permit to cancellation.
certify that I have read this application and stat at the ab informatio is correct. agree to comply with all
city and county ordinances and state laws relay g to building co truction, a here authorize representatives
of this county to enter upon the above-mentio d pro erty for in coon purp
Date w Signature.lApplicant or A L' - /
Application Number . ... . . 05-00003673
Permit PATIO COVER PERMIT''
Additional desc .
Permit Fee 72.00,. Plan Check
Fee,.
46.80
Issue Date Valuation
4057
Expiration Date 2/15/06
Qty Unit Charge Per
Extension
BASE' FEE
45.00
3.0.O 9.0000 THOU BLDG 2,001-25,000
)
27.00
Special Notes and Comments
��
305 SF ALUMAWOOD LATTICE PATIO COVER
PER CITY STANDARD
----------------- -
Other Fees . . . . STRONG MOTION (SMI)
- RES
.50
Fee summary Charged Paid Credited
Due d
Permit Fee Total 72.00 .00
.00
72.00
Plan Check.Total 46.80 .00
.00
46.80
Other Fee Total .50 .00
.00
.50
Grand Total 119.30 .00`
.00
119.30
LQPERMIT _
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