04-3717 (PAT)1414 QUjArC4Lj
BUILDING & SAFETY DEPARTMENT
P.O. Box 104 (760) 777-7012
78-495 CALLS TAMPICO FAX (760)777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .. . . . . C3410_0_0_0_=3_71 7 Date
Property Address . . . .. . . 80345 VIA VALEROSA
APN: 772-250-999-39 -30357
Appl.ication description PATIO COVER - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
. .....Application valuation..... 5187
Owner
Contractor
------------- 7 -------------
JOE DAVIS
------------------------
LADDIN SUPPLY & CONSTRUCTION
80345 VIA VALEROSA
8211 RAMON ROAD
LA- -QUINTA.
CA.
THEDRAL'CITY
CA 9223.4'
C STATE FUND
C: 00135312003
09/18/04
C B015727...
11/01/04
Ar
CCC:
----=-----------------------
Permit . . . . .
---- ----------------------------
. PA COVER
---------------
PERMIT
Additional desc
Permit Fee
81.00
Plan Check Fee
52.65
Issue Date*
Valuation
5187
Qty Unit Charge
Per
Extension
BASE
FEE
'45.00•
4.00 9. 0000
THOU BLDG
2,001-25,000
36.00.
------------- ----------------------
Special, Notes and.
-----------
Comments
------------------------
390. S*.F.ALLUMAWOOD
PATIO 'COVER ICBO RPT
2621P
----------------------------
Other.Fees
-----------------------------------------------
STRONG MOTION (SMI) RES'
..51
Fee summary
- - - - - - - - - -
Charged
- - - - - - - - - - -
Paid Credited
Due
- --
Permit Fee:Total
-
81.00
- - - - - - - - - - - - - - - - - 7-
.00 ..00,
- - - - - -
81.00
Plan Check Total.
52.65
.00
52.65
Other Fee Total.
.51
.'.00
.00 00
.51
Grand Total
134.16,.
.00 .00
134.16
P.O. BOC 1504 a QUMw
78-495 C:ALLE TAM/ICO
LA QUINTA, CALIFORNIA 92253
Application Number: OL
Applicant:
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
Architect or Engineer.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4 -A-7
Architect or Engineer's Address:
--i Jcf�cfl,
Lic. No. / & 2_ --73
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 affrm under penalty of perjury that 1 am kensed under of OwPi8r 9 (mmnembV with Sation 7000) of Division 8 of fie Buuneu and Professionals
and my License krl force and eBecl
License Class No.
I hereby -ft..h under ply of perjury t,al I am°NW'�
ERDER DECLARATION
Prot from" Contractors• Stab License Law for ft Mowing reason (Sec 7031.5. Business and Professim Coda: Any
Wlema yflrat he k b pct. albr. Ynpowe. dernoistL «ropair any ouCture. prior b its issuance. also repuires the appianl br fro pemril b fie a signed
PurvAra to the provisions 011W Contractors' state License Law (Chapter 9 (Commencing with section 7000) d Division 8 d he Business
and Professions Code) or that he or she is exanq Neuron, and the basis f« Mie staged exemptiorL Any viohation of section 7031.s by any appiearM for a permit subjects
the applicant 10 a dvl penalty of not more than five kxxked dotars (Saco) r
U I, as owner of the properly. Or MY arrmployees with wrapet as their sob Corpmhsation, will do the wodi_ and the structure Is not intended or oft for safe (Sec. n".
Business and'Professions Code: The CCntraotors' State License Law does not apply to an owner of properly who builds «improves fnneon. and who does to work
hirnself orf o or through his or her own employees, provided that the inprovernents are not Intended or ollo f« sate. If. however, the building «inprvvement is
sold withinU Las owner of he 3� o(� ti he owner4A1der will. have the burden► of proving that he or she did not build or imprave for the purpose of safe.).
State License Law does nmol Y conbvc&V "ft icerhs A lo construct the project (Sec 7044. Business and Piofessions Code: The contactors•
appy to an om m of property who builds «improves 1111eie0n, and who Contracts for to projects with a contract0r(s) licensed pursuant to
the Contractors! stale License Law.).
U 1 am exempt under sec. _ . S.3 P.C. for this mason
Date Owner
1 hereby affirm under penalty COMPENSATION DECLARATION
Penalty at palmy one of the following declarations:
_ 1 have and will maintain a certificate of cwm t 10 setinsure for workers' compensation, as provided for by section 3700 of the Libor Code. for the pertarrrhanop
.' hy( of the work for which this permit is issued
,��gl lhave and will maintain workers' Corrparhsa6on ckaance. as required by sedan 3700 of ft Labor Code. f« the performance of the work for which tris pe.n. Is
M0 `vQorlap°ntati°" `a"i°rand
l� " I'�arr003
1 y > lo tIa tPalm+r�•� of the work
^ taco of for which tar a issuad.is pel shall not employ any person in any manner so as to become subject to On workers'workers'kers•
Camo
Omh% and agree that. ff 1 slit uld become subject to the wCrkerc'
v �p�p�y with ��prov�t
Compenprovisionsn provisions of Sector, 3700 0l ft Labor Cade. l shall
27 0I
WARNING: FAILURE NE SECURE WORKERS DDOLLARS($tCOMPENSATION CpyERgGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP F ONE FBOR C D THOUEANp DOLLARS (8100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR W
SECTION 8708 OF THE LABOR CODE. INTER AND ATTORNEYS FEES. .
I hereby affirm under penalty of perjury that thereiCONSTRUCTION LENDING AGENCY
Lerndefs Name s a oonudrtuction
Weldrqncy agefor the performance of the work for which this permit is issued (Sec. 8097, Civ. C.).
Lenders Address
IMPORTANT Application is thereby malde 10 the Director of APPLICANT ACKNOWLEDGEMENT
1. Each person upon whose behalf to the
SukWV and Safety for a permit subject b the condiums and restrictions set forth on tis appfwsfiom.
Issued es • upon
of tis a application is made, each person at whose request and f« whose benefit work is performed under or Pursuant 10 any permit
officers. spats a� �bOn• # ONR1e!• and he applicant, each agrees 1o. and shall. defend, indemnify and hold harmless the City of La Quinti. its
2 Any petit issued as "VIOY t of for
a ny act or omission related to the work being performed under or following issuance of this pemiL
Cessation of work for 180 da will Pplication becomes null and void M crone a not commenced whin 180 days from date of Issuance of such pan, «
to
1 certify that 1 have read Ns application and state that th�above int
construction. and hereby authorize ropresertatives of this fe correct 1 agree io comply with alt icityns and county ordinances and state taco relating b building
. county b era firs above-mentioned property for inspection purposes
(Applicant
or Agent):
CITY OF LA QUIl
BUILDING & A'E C
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