05-0190 (PAT)fn,
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA"QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . ...05-00000190
--: Date:
1/19/05
Property Address . . . .
80090 VIA VALEROSA
"APIC:
772-250-999-9 —30357 -
Application description ..
PATIO COVER - RESIDENTIAL
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation
6650
Owner
Contractor
LIZ CLAPPER
ALADDIN SUPPLY &"CONSTRUCTION
80090 VIA VALEROSA..
68211 RAMON ROAD
LA QUINTA CA 92253
CATHEDRAL CITY
CA -92234
(760) 321-1277
WCC: STATE,FUND
WC: 0013531
09/18/05
CSLB: 501572
11/30/06
CCC: B
Permit . . PATIO COVER PERMIT
Additional desc
Permit Fee . . . . 90.00
Plan Check Fee
58.50'
Issue Date
Valuation
6650
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 21001-25,000..,
4,5.00
Special'Notes and -Comments.
500 SF. ALUMAWOOD"PATIO COVER
Other Fees . . . .
STRONG MOTION -(SMI) = RES;
.66
Fee summary Chargees
Paid Credited
Due
Permit Fee Total 90.00
.00 .00
90.00
Plan Check Total 58.50
.00 .00
58.50
Other Fee Total 66
.00 .00
.66
Grand Total 149.16
00 .00`
149.16
r _,
P.O. Box 1504 'GC���
VOICE (760) 777-7012
713-495 CALLS O FAX (760) 777-7011
LA QUINTA, CALIFORNIAFOR 922534V INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: .S' 0 Date: - O.5
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
ode, and my License i61n full force and effect. .1 --License
License Class J� (i n1 Lijcense No. I 1
/'Date --e0�itractor A �ij UI Ul � 1 � oyoi
l_ OWNER-ByfLpER DECLARATION
I hereby a rn Jncler penalty of perjury that I am exempt from the Contractors' plaV 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 re it 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 Contractors' 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).):
U 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 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 or 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.).
U 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.& P.C. for this reason
Date Owner I
WORKERS' COMPENSATION DECLARATION
I hereby 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
liof the work for which this permit is issued.
tl have and will paintain workerscompensa ' n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
( is M orkers' com ensatio. ti mance cam%pal lip ber are:
f u y p /yV Y�j'�j'i
arrier Policy Number
I certify that, in the performance of the work for which this permit is is ed, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, agree that, if I shoul
forthwith comply with those proor s. d be a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
vi _ �, ,�_
Date I O
WAKNINtb: FAIILURE TO SECURE WORKERS' CbMPENIP TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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.
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
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 Ouinta, 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 n 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 cancel li n.
I certify that I have read this application and state that the above info ati is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
onstruc 'o , a d hereby authorize representatives of this county to en r on the above-mentioned y for inspection purposes.
ate nl -4
ignature (Applicant or Agent):
J