05-4942 (PAT)t-
T4ht 4
P.O. BOX 1504 VOICE (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: 11/04/05
Application Number: 05=00004942 Owner.
Property Address: 79754 VIENTO-DR BULLARD JOHN
APN: - 609-380-998-25 -293232- 79754 VIENTO DRIVE
Application description: PATIO COVER - RESIDENTIAL oLA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL LA QUINTA, CA 92253 '
Application valuation: 5852 D
Contractor:
Applicant: Arcti tect or Engineer: ® �j®� MIRAGE BUILDERS
27372 MERIDIAN" WAY
LAGUNA NIGUEL, CA 92677-
(949)235-1202
2677"(949)235-1202
ti✓ Lio. No.: 792314
4y
----------------------------------------------------
• LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I 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: B icense No.: 792314 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
.issued. .
_ate: ,Q ntractor: 00I 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 EXEMPT Policy Number EXEMPT -
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 sheislicensed pursuant to the provisions of the Contractor's State and agree 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 ode, I sh fort ith con1pp th those provisions.
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).: te: OS icant:_ '
(_) 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 L _
and who does the work himself or herself through his or her own employees, provided that the . DOLLARS 1$100,0001. 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
(_) I, 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 contractors) 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,
(_ 1 I am exempt under Sec. , BAP.C. for this reason the owner,,and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 void if work is not commenced
within 1.80 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.- '
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building con union, and hereby thorize representatives
of this tt unt to nter upon the bove-mentioned ropert r m ctio urrRRR,osees�'
ate: / y S' pature (Applicant or Agen)�L/+�L%
Application.Number 05-0.0004942
Permit PATIO COVER PERMIT
Additional desc .
Permit Fee 81.00 Plan Check
Fee'
52.65
Issue Date' - Valuation
5852
Expiration Date 5/03/06
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
440 S.F. ALUMINUM LATTICE PATIO COVER'
Other Fees . . . . . .. .. STRONG MOTION (SMI.)
- RES
.58,
Fee summary Charged Paid Credited
-'
Due .
Permit Fee Total 81.00 .00
.00
81.00
Plan Check Total 52.65 .00
.00
52.65
Other Fee Total .58 .00
.00
.58
Grand Total 134..23 .00
.00
134.23
LQPERMIT '
hO
Bin #
City, of La Quinta
Building U Safety Division
P.O: Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: cl - U �' O r
Owner's Name:
A. P. Number:
Address:''q.'TbU br
eve
Legal Description:
City, ST, Zip: (' -� ,f} a� 53
Gt vll n o�
Contractor: A , e --9U rS
IiI
lit
,... r
Telephone: 760 s7 /42, 6
Project Description:
Address: 7 Gt - 61 V , e D r
City; ST, Zip: l.0. a,: J,:��
CA- 9 $3
,4[��lirl�wl � Ice �a io Cover
Telephone: 7 W- 360 -v 10
r g
t
State Lic. # : -7 Q ';I.3 City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
�-
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'r Alter Repair Demo .
Name of Contact Person:
Sq. Ft.: �. �(�
#Stories:
#Units:
Telephone # of Contact Person: 6 p - .3 60 —.d I Q I
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
W'.
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount .
Structural Calcs..
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked. up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2nd 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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appy
Date of permit issue
School Fees
Total Permit Fees
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TY OF LA QUINT,
BUILDING & SAFETY DEPT.
• - APPROU
Eli
FOR CONSTRUCTION
- DATE � I�BY � ' • M1 , '
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Aiv
i9-754 VIBUO DRIVE, � J
RING, INC _ 0517!9/0
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