0309-093 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby 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 Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). i i
() I am exempt under Section , B&P.C. for this reason
Date '. is', Signature of Owner .i (i.(. , v.
/WORKER'S 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 of the work for which (his permit is issued.
( ) I 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 insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree tha if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thoseprovisions.
Date: %_ i '..Applicant—.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit 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, 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 State laws relating to the building,
construction, and hereby authorize representatives of this City to enter upori
the above-mentioned property for inspectionjpurposes.
Signature (Owner/Agent) _ �1 ' Date
BUILDING EHIVIIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN &NEER
Q101Y47A Wk
USE OF PERMIT
3=.p: f101:'CNER, PIER APPROVED
PROW"" V01 SUAAWty
C..ONS f"R i 47T10N F" l (-1-i,00-•9 F is-ov. $ lc &6
"
STRONO MOT10W FEE -REa!V) 101-Ut1L-24.1-400
o,�P 09 2003
FINANCE DEPT.
�ti�-"1�C��!�".. �':'C?���'.���?1w�Cr9j?i•.f!�'t.I.�S:F:i<t�11 C.`Ij.�'.�"rvl,a�'i,•*�
�>f?,i!.�5i!
G7!
1t�t?
RECEIPT
DATE
BY
DA E FINALED
JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final —
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
;Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
RAFTER SIZE AND SPACING
--'2x ---
l ---
-ROOF
R 6OF PII/TCCH
— — —.
.b •. f INE.
coNn UOUS LEDGER
(SAME SIZE'AS RAFTERS)
HEADER..SIZE
RAFTER SPAN:
.
F O:M
OVERALL LENGTH:
T AND 'L' STRAPS
N
SETBA(
"■Ca1't1/8" WITH
2000 P.S.I CONCRETE --+'i
I FINISH GRADE
L_J
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE: ROOFING OTE ON REVERSE)
NOTE:
OPEN LATTICE PATIO COVERS MAY BE. ATTACHED TO EXISTING FASCIA
VIA,ONE 1/4' x 5" LAG SCREW -THROUGH FASCIA INTO EACH RAFTER TAIL.
U-; -STRAP OR ANGLE —
3/8" ■ S' LAG SCREWS INTO STUDS AT 16" D.C. :NON' -CORROSIVE PLATE
CONTINUOUS LEDGER.]f �'N
II II II
('4) 16d NAILS
OR BOLT
U–STRAP OR ANGLE
t
(4)– :1.6d NAILS
OR BOLT
JOIST HANGER' OR SOLID'BLOCKING !7.
NAIL RAFTER TO BLOCKING'
PROVIDE 1" eCLEARANCE
BETWEEN POST `AND
'..CONCRETE
BUILDING DEPARTMENT, APPROVAL `BELOW'
PROVIDE .1" CLEARANCE
BETWEEN POST AND
CONCRETE -�
ANCHOR BOLT (EMBED
7" MIN, INTO, CONCRETE)
TYPICAL PATIO COVER
�'DATE Of APPLICATION ^-
03
- • ter .:.:.
OWNER'S NAME . Mtw le. 6 Aj�/,/ i
y,
STREET ADDRESS
CITY•, ST ZIP
TELEPHONE
H.O.A. APPROVAL
F_�
T AND 'L' STRAPS
N
"■Ca1't1/8" WITH
16C NAILS OR BOLT
I4)
I
POST SPACING:_1__
Ox
,a
a
f
• OVERALL. LENGTH SG___
6j.
POST SIZE:x
-SIDE SETBACK"
-(4'Y4' MIN.)
FINISH, GRADE
i
J MIN. 12':12' FOOTING I I
L— 12', BELOW GRADE L- _ J
NOTE:
OPEN LATTICE PATIO COVERS MAY BE. ATTACHED TO EXISTING FASCIA
VIA,ONE 1/4' x 5" LAG SCREW -THROUGH FASCIA INTO EACH RAFTER TAIL.
U-; -STRAP OR ANGLE —
3/8" ■ S' LAG SCREWS INTO STUDS AT 16" D.C. :NON' -CORROSIVE PLATE
CONTINUOUS LEDGER.]f �'N
II II II
('4) 16d NAILS
OR BOLT
U–STRAP OR ANGLE
t
(4)– :1.6d NAILS
OR BOLT
JOIST HANGER' OR SOLID'BLOCKING !7.
NAIL RAFTER TO BLOCKING'
PROVIDE 1" eCLEARANCE
BETWEEN POST `AND
'..CONCRETE
BUILDING DEPARTMENT, APPROVAL `BELOW'
PROVIDE .1" CLEARANCE
BETWEEN POST AND
CONCRETE -�
ANCHOR BOLT (EMBED
7" MIN, INTO, CONCRETE)
TYPICAL PATIO COVER
�'DATE Of APPLICATION ^-
03
- • ter .:.:.
OWNER'S NAME . Mtw le. 6 Aj�/,/ i
y,
STREET ADDRESS
CITY•, ST ZIP
TELEPHONE
H.O.A. APPROVAL
F_�
RAFTER SPAN TABLE
GRADING RULES S�
PS 20-70 V �
(FEET & INCHES) opJA�?
"' ,per C V�
2x4
16" O.C.
24"
10'-6"
1 9'-6"
1 7'-3"
8'-9"
8'-6" 1 8'-0" 6'-0"
7'-3"
DOUGLAS FIR
NO. 1
2x6
16" O.C.
2,C
32" "
15'-0"
14'-0"
10'-9"
13'-0"
12'-6" 11'-6" 8'-9"
10'-6"
10'-0" 8'-6" N/A
N/A
4x6
6'-0"
2x8
16" O.C.
24" . "
32" "
18'-0"
17'-0"
13'-6" 16'-0"
15'-6" 14'-6" 11'-0" 113'-0"
13'-0" 11'-6" N/A N/A
10'-0"
NOTES: .
1. 32" RAFTER SPACING IS .ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED TO 10'-0" USING
THIS STANDARD.
LATTICE
ROOF
BUILT-UP
ROOF
HEADERS
HEADERS
I DOUGLAS
FIR NO. I
DOUGLAS FIR
NO. 1
SIDE
SPAN
SIZE
SPAN
4x4
5'-0"
4x4
4'_n"
4x6
8'-0"
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
4x10
14'-0"
400
10'-0"
4x12
171-0"
402 2
1 2'-0"
6x8
14'-0"
.6x8
1 ^'-0"
600
17'-0"
600
1 4'-0"
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE:.
AW1 CALIFORNIA BUILDING CODE.
SUPPLEMENTAL NOTES:
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
OWNER/ BUILDER • INFORMATION
Dear Property Owner:
r
An application fora building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as ''Owner/.Builder`' you are''the responsible party of record on such a
permit. Building permits•are not required to'be signed' by property owners unless they are.personally performing their
own work. If your work.is being'_peiformed by someone other than,youiself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They -are` also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades. that°you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family;=and the work (including materials
and other costs) is $200.00 -or more' for ' the: entire project, and such, persons • are not licensed as contractors or
subcontractors, then you may be anemployer.
If you are an employer, you°must register with the, State and Federal'Government:as.an�employer•and you are subject
to several obligations including -Slate and. F.ederal'-income,-tax withholding federal-sgcial security taxes, worker's
compensation insurance, disability insurance costs and unemploymentcompensation contributions.
There may. be financial. risks for,you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance. .
For more specific information about your obligations under Federal Law, ,contact the Inteinal Revenue Service (and, if
you wish, the U.S.-Small Business-Adminstration). For mole specific infotmation abouryour obligations under State
Law, contact the Department of Benefit Payments and ihe'Division of Industrial Accidents.
If the structure is intended for sale, property -owners who are not licensed.contractors'are allowed to perform their
work personally or through their own employees, wtthou ;a lic'ensed.con'tractor or subcontractor, only under limited
conditions. -
A frequent practice of unlicensed'persons professing to'be.contractors-is to secure an,,"Owner/ Builder" building
permit, ,erroneously implying. that the property owner:is.;proyiding his`or her own labor and material personally.
Building permits are not required to be signed by .property owners unless they are. performing 'their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board_ in your
community or at 1020 N. Street, ,Sacramento, California 95814.,
Please complete and return the enclosed owner-builder,verifrcation formso.that we can confirm that you are aware of
these matters. The building permit will not be=issued until the verification is'ietuined:
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tamo p•
La Quinta, CA 2
(760) 7177-701E f
'S' SIGNE/DATE
Ja^ /5s D
PROPERTY ADDRESS
0s�Q2 — 6.2. ct.3 I I .
PERMIT NUMBER(s)