04-3708 (PAT)w
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
7.8-495 CALLE TAMPICo FAX (760) 777-7011
LA QUINTA. CAi iFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
- BUILDING PERMIT
Application Number 04--000 037 08__ /04
Property Address �`4�8213 VISTA DE N L
APN: 646-110-081-7 052 -
Appl.ication description PATIO COVER - RE D NT�I2� 2004
Property Zoning LOW DENSITY RESIDE IA
..Application valuation. -3950 CITYOFLAQUINTA
FINANCE DEFT.
Owner Contractor
PETRICKA FRANCIS YBARRA CONSTR CO, TONY M.
48213 VISTA DE NOPAL 566 STURGEON DRIVE
LA _QUINTA : CA 92253 COSTA'.MESA . CA 92626
WCC: STATE FUND
WC: 6537952004 01/01/05
CSLB: 344248.. 04/30/05
CCC: C61 -D3.-051' 24
Permit . . PATIO COVER PERMIT
Additional desc
Permit Fee. 63.00 Plan Check Fee 40.95
Issue Date Valuation 3950
Qty Unit:Charge Per Extension
BASE FEE 45.00•
2.00 9.0000"THOU BLDG 2,001-25,.000 18.00
Speciale Notes and,Comments
297 S:F..ALUMAWOOD LATTICE PATIO COVER.
ICBO PLANS 5580
-------------------------------------------------------------------------------
Other.Fees _STRONG MOTION (SMI) - RES .50
Fee summary. Charged Paid Credited Due
Permit Fee,Total 6.3.00 .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
P.O. BOX 1504 a �
78-495 CALLE TAM►ICO
LA QUINTA. CALIFORNIA 92253
Application Number:
Applicant:
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
P
VOICE (760) 777-7012
FAX (760) 777.7011
INSPECTIONS (760) 777-7153
Dat `'t-1�01Z"1-04{
Architect or Engineer:
Arphitect orEngineer's Address:
Inc. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty d perjury bat I am ficamse0 under provisions d Chapter 9 (Commencing wtb Section 7000) d Division 3 d the Business and Prolessionefs
/Code. and my License# ink/ force and efFea / r� , / G�
License Class GO, // /Lroense No. / ;"`1 D
I hereby alum under penally d perjury bat I am OWNERA UILDER DECLARATION
�y or o�mty that requires a permit b cher. improve. from Ons Contractors' Stab License Law for the fobwirnp reason (Sec 7031 6. Business and Probssions Coda: Any
staterihemt that he «she b kmtsed � vW*M do molislL « repair any stru hit pri« b as issugrum also requires the applicant f« the permit b Oka signed
Pur>Ws exempt
pt prwish cru d be Cantracbrs' State License Law (Chapter 9 (Commencing with Section 7000) d Division 3 d One Business
and Professions Code) Or that he or do k exempt benehom and the basis for the stagged exernpdon ._ Any violation d section 7031.5 by any applicant for a permit subjects
Ore applicant to a civil penalty d not more than live hundred dollars ($500).):
U I. as owner d the Property. or my employees wile wages as their sob compensation, will do be work, and the structure is not Mended «offered for sale (Sec 7044,
Business and Professions Code: The Contracfo fs' stale License Law does not apply b an owner of Property who builds or improves bersom and who does the work
himself
w�orr through his «� or 0own employees, provided that the i rprovements are not Mended or offered for sale. H. however. the building «inprovement is
MW hin one year of completion, the Owner Wilder wild have One burden of proving that he or she did not build «improve for the purpose of sale.).
U I, as owner a the property. am apply to an contraowner the wile icansed contractors b Construct the Project (Sec. 7044. Business and Professions Code: The Ca+trsclore
SUM License Lew does not appy.) an owner d p operty who builds or thaieon, and who contracts for the Projects with s s
the Contractors' Stade License law.). carmtractor( ) licensed pursuant to
U 1 am exempt under sec . BA P.C. for Oils reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of pe" one of the following declarations:
_ I have and will maintain a certificate of consent to seWnsrue for workers' compensation, as provided f« by Section 3700 d the Labor Code.
d nult ler One pertamnarnoe
the work for which this per.. Is Issued
_ I have and will maintain workers' compensation insurance. ass mWireydmbby Section 37M of ft Labor Code, for the performance of the work ler which bis permit is
— I � De / lm i=ky ler whkh Ors pemnrt is issued. I shah not
CaMomia, and apes that, V 1 should beoonhe y °^1' mon in any roamer so as b Oecortne subject b the workers'
bMwft �y with �e D�sions. subject b the workees' compensation provisions d Section 3700 d be Labor Code.1 shall
WARNING: FAILURE TO SECURE WORKERS qt Pp . n GE IS UNLAWFu, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (it00. ). Or ADDITION TO THE COST OF COMtPENSATION, DAMAGES AS PROVIDED FOR
SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. . IN
1 hereby affirm under penalty of perjury bat bareis a Construction CONSTRUCTION LENDING AGENCY
n9 agerxy ler the Perfaman0e Of the work for which On Pot.. I is issued (Sec. 3097. Civ. C.).
Lenders Nam
Lenders Address
IMPORTANT Application is -hereby mn►de b Ore Oirecbr d APPLICANT ACKNOWLEDGEMENT
Building and Safety for a permit object to be Conditions and restrictions set forth on cis
I Each peresult rson � applicatiM apppicationis �m�e, each person at whose request and f« wt wse benefit work is performed under «a Pais b any pem *
officers, agents and ePpbcant, each agrees b, and shall, defend. indemnify and hold harmless the City of V Oukmta, its
2 Any permit ad as • results for
act or omission related b the wok being performed under or fdbwing issuance d this pemniL
Cessation pe m tI nook for 160 sur f this
ill application bomn" null and void K work is not Commenced within 160 days from date d issuance of such Pei" «
I certify that I have read this a bject Dmm b cancellation.
construction. end hereby is applicalioneseepl ntaat es d Ohis lhe above MOrmation is COMIM 1 agree b comply with all city and county ordinances and state laws relating to building
County b eller upon the above-mentioned property ler inspection purposes.
Date b 11 i5rgnakre (Applicant «Agent}.�-
f�
L
L