08-1192 (PAT)P.O.*BOX 1504
78-495- CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00001192 Owner:
Property Address: 78960 VIA FLORENCE K " " HARRISON VICTOR C
APN: 643-110-028-227 261'52 1790 SUNNINGDALE RD NO 15B
Application description: PATIO COVER - RESIDENTIAL. SEAL BEACH, CA 96740
Property Zoning: LOW DENSITY RESIDENTIAL (562) 598-5104
Application valuation: 3485
Applicant:'"
Architect or Engineer:
Contractor:
LA QUINTA PATIO COMPANY -
40133,CALLE LOMA ENTRADA
BERMUDA DUNES, CA 92203
(760)863-4335
Lic. No.: 449379
1,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/14/08,,
US1 2 0 a a
CITY OF LA QUINTA
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
_
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:.
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and•effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
- License Class: C51 'cense No:: 4493.79
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
''1 /
issued..
. -Date." 19 Contractor:— ^._�.
_ 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
OWNER -BUILDER DECLAR TION -
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 ENDURANCE REIN Policy Number WEN0003727-02
" following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance 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 manner so as to become subject 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 should become subject to the orker ' comperlation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of. the Business and Professions Code) or
- 3700 of the Labor Code shall forthwith m i ions.
" • that he or she is exempt therefrom and the basis for. the alleged exemption.. Any violation of Section 7031.5 by
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).:
�Dafe-'�� `�Applicanti"—�
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
-—Ay L, , V-
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
. WARNING: FAILURE 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
-
- - - improvo fer the purpeaa of
APPLICANT ACKNOWLEDGEMENT
(_ 1' 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.). -
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 - -
- - -
within 180 daysfrom date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY
permit to cancellation. ..
1 hereby affirm under penalty of perjury that there is a construction lending agency fortheperformance of the -
I certify that I have read this application and statethatthe above information is correct. I agree to comply with all �.• "
.. work for which this permit is issued (Sec. 3097, Civ. C.): + ' - -
city and county ordinances and state laws relating to building construct io h uthori presentatives. .,
of this county t enter upon the above-mentioned p y for inspecti se
Lender's Name:
-
�.
w Agent):
- Lender's Address:
DateL Signature (Applicant or _
LirtY
LQPERMIT
Application Number .. . . . . 08-00001192.
Permit . . . . PATIO COVER PERMIT
Additional desc .
Permit Fee' 63.00 Plan Check
Fee
40.95
Issue Date Valuation
. . .
. 3485
Expiration Date 1/10/09 _
Qty Unit Charge Per
Extension
BASE FEE
45.00 -
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
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Special
Special Notes and Comments
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-
--- - - - - -- -77-
ALUMAWOOD SHADE STRUCTURE PER APPROVED
PLANS BASED ON 2006 IBC CODE &2007 CBC
CODE
- Other Fees . . . . STRONG MOTION (SMI).-
RES
.50
Fee summary Charged Paid Credited
Due
e
Permit Fee Total 63.00 .00
00
63.00
Plan Check Total 40.95 .00
.00
40.95
Other Fee Total .50 .00
.00
.50
Grand Total 104.45 .00
.00-
104.45
LQPERMIT ' - -