11-0351 (PAT)P.O. BOX- 150VOICE (760)777-7012
' 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA;.CALIFORNIA 92253' BUILDING & SAFETY=DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT,
Date: 4/08/11
Application Number. X11 00000351. Owner:
Property Address: 79105 'VICTORIA DR ' HOSTETLER - EDDIE
APN: 604,-373-004-36 -27899 - 79105 VICTORIA DRIVE
Application descriptions •PATIO. COVER - .RESIDENTIAL , LA ,QUINTA, CA .92253:
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: .3352
Contractor:
Applicant: Architect or Engineer. VALLEY PATIOS"
j�-- 37.897 CHESTERFIELD S T
BERMUDA` DUNES, -CA '92 3 ." App p
760 534-4634 APR: 08
• c > 2011
Lic. No.: 937811`
CITY OF LA QUINTA
FINAN e AFPT
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 7000) 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 ' " - License No.: 937811 for by Section 3700 of the Labor Code, forthe performance of the work for which this permit is
+ I issued. .
' -
-Date:. Contractor: � � _ 1 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 DECLARATION _ .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 STATE FUND' Policy Number - 713-'6034044 -
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 whichthis 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 sous 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 provision's of the Contractor's State andagree that; if I should become subject to the workers' -compensation 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, I shallforthwithcomply. with tthjhoo� provisions. -
that he or she is exempt therefrom and the basis for the alleged exemptin. Any violation of Section 7031.5 by
o.�.." ,-
any applicant for a permit subjects the applicant to'a civil penalty of not. more than five hundred dollars ($500):: (Date:, -1 Iy 4pplicant: v ' -
' (, 1 1, 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 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 1$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
improve for the purpose of sale.).- - ,. -. APPLICANT. ACKNOWLEDGEMENT • .
h_ 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 fora 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'* 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 anyact or omission related to the work being -
' performed under or following issuance of this permit..-
Date: Owner. - 2. Anypermit 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, qr"cessation ofwork for 180 days will subject '
• ` - CONSTRUCTION LENDING AGENCY permit to cancellation.
Lhereby affirm under penalty of, perjury that"there is a construction. lending agency for the performance of the. - I certify that I• have read this application and state that the above information is correct.I agree to comply with"all "
work for which this per is issued (Sec. 3097 Civ. C.1. - city and county ordinances and state laws relating to building construction;. and hereby authorize representatives
of this county to enter upon the above-mentioned property for iiin/s�/9y�io'n purpos -
Lender's Name: - q� i -"----
Date. 70-1' Signature.lAPPlicantorAgent): ..
Lender's Address: -. _ - - -
Application. Number .'. -. 11-00000351
::;Permit:: PATIO COVER
PERMIT'
°;. Additional desc':.
ermi`t Fee 63.00.,.
Plan -Check
Fee ,.:..
4.0.95.
Issue, Date, :.: -., ...
Valuation:
335-2.
Expiration Date .. .10/05/11 -
Qty Unit�Charge Per-,
_
Extension
_ BASE
FEE
-..
45.00
2:700 .` :'9.0000 THOUBLDG
2,001-25,'000
18.00
------------------------------------------------------
Special Notes and Comments
-PATIO COVER TOTAL OF 252 SQUARE FT.
PER
' APPROVED PLANS 2009. IBC, 2009 IRC;.
2010
CBC.
-------.----------------------
.Other Fees . . . . . BLDG STDS ADMIN (SB1473)
--------------
1.00
Fee summary Charged
Paid .Credit:ed
Due
Permit Fee Total 63:00
----,--- --------
_ .00
.00.
63-.00
Plan Check Total 40:95•
00
.00
40:95
Other Fee Total 1'.00
.00
:00
1.00
Grand Total 104.'95
00
.00
104.95
LQPERMIT
'
Bin '.# 1
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City..Of LM •Q..0
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Building 8T'Safety Dh4slori .
.
Permit #
„ . P.O. Box 1504, 78-495.Calle Tampico
La
Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and. Tracking Sheet
Project Address: 7� (,Q�
UIC,�Uf t t? Dr.
Owner's Name:
A. P. Number:
Address: 77°(1 a=j. ' V, c_ r t�0.
Legal Description:
City, ST, Zi Q�'11 ,/`� � q—z-- 'E>-3
P� i� lXvi
+
`r I
Contractor: V 0� \ �'e
C�
Address: 7 '1
r
Telephone:
s
Project Description:
'
City, ST, Zip: r!/,-` O
Telephone:- 7(oS34— 63
s .,...
2Gl/ -�lh ✓e
State Lic. # : l7. [I
"(
City Lir ..
c: #.:
•
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:ti••,
a>
�
nstruction Type:Occupancy:,
cy:,
State #:`°
-
Lic:
;,,:: ';
Project'type 'n
• • a , . •:.:,�`
(circle one): New AddAlter Repair Demo
Name of Contact Person: Arld altv '
Sq. Ft.: `Zrj �Z
_
# Stories:
# Units:
Telephone # of Contact Person: —7
0 — � -L( (7 �) L
Estimated Value of Project: -� J 5
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted.'
Item f Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
'"
Construction
_
Flood plain plan
Plans resubmitted
-
Mechanical"
.
i
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A,.Approval
Plans resubmitted
Grading
IN HOUSE:-
''''Review, ready for correctionsfissue
Developer Impact Fee '
-
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees"
Jr
Total Permit Fees
i