0103-0202 (PATIO)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 # f Lic. Class `�% Exp. Date
Pr
I Date "� rf>% jSignature 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 am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
.1 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 this permit is issued.
(r) 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.
XWE POND 0460 -UNIT M4942z
(This section need not be completed if the permit valuation is for $100.00 or less).
(I) 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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, 1 -shall forthwith comply with those-pfovisions
Date: ' tp % •, Applicant k I Lz, J( %4-
j Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions setyforth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is•performed under or pursuant,to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize, representatives of this City to enter upo
the above-mentioned property !or inspection purposes. ppO /�
d , } f
Signature (Owner/Agent)'- . :D��F 'I �i s � ' �. ate' °%%% � r t
BUILDING PERMIT PERMIT/f
DATE VALUATION LOT. TRACT
JOB SITE
APN
ADDRESS
,,��11��yy q�rr App ry;yA pq,ryy�x�v
Wind" *R. k LBB Qrt� idRI
OWNER
CONTRACTOR / DESIGNER / EN (NEER
43.675 AWA C:GUIr '
754 W ILLT- 8�b�n3MA I
LA QUIUA (,'A 92253
CA 92264
USE OF PERMIT
TSS E AVF, V 1 1'.Kf TAT 0496 TO FACff OF HCaUS & FASCIA T O B R A°
KASONI-T"r,43.a4 .N x ED TO MATCH, 2 'S'XW PA14 BEAMS SUPPOit`.f`ED BY 4
PORCHIPATIO 602,00 SP
FISM"IFID CMI OF c0fiSTRUMOV
Prbf<� CHECK KRE
017MOI['1`6Mr'$Of
>M`AT,RWRIXYMO .NID����.t��.,yyAi�i�yyC�i3y:��t�:`yl���Y��-rry�y
$176.y20
�413'M P,Ku+- .t'A�I.A .I;.G`a4S'A7
10100
A Aie PER -w• Y ly-:; DUB NNW
s;a ug
'
MAR 2 8 2001 ����������������������
02
IE
RE E(
OF LA 0 INTIK �,,•
BY
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DAT FOALED O
INSPECTOR
CITY t
w
l/O
4
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
O.K. to Wrap
F.A.U.
Framing
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
BLOCKWALL APPROVALS.
Final
POOLS - SPAS
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS.-
OMMENTS:Final
E.
`-
TUS
Calif. Contact=
F�
L .
C
License No. M256
WN/NG
754 Wilhams Road
L
and SCREEN
Palm Springs, CA 92264
L,
CA-J 3
PH: 760-327-8466
FAX: 760-327-8467
Park:
V ►S Phone: - 8�
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I
_...,ru VARIES
SEE SCHEDULES
DRAIN
OPT. 3 1/2" CONC SLAB %
SEE NOTE # 5 ON
SHEET 97GN02.
MULTISPAN ATTACHED CANTILMED STRUCTURE
FOR COLUMN SIZE SEE —
"COLUMN SCHEDULE"
NOTE: PATIO WIDTH VARIES W/ SELECTION
OF HEADER, NUMBER OF COLUMNS
AND LOADING CONDITIONS. SEE
SCHEDULES FOR MAX. COLUMN SPACING. /
L
HEADER
FASCIA
OPTIONAL
OPTIONAL 3 1/
CONCRETE SLAE
SEE NOTE # 5,
SHEET 97G 02.
SEE SCHEDULE FOR
FOOTING SIZE
FOR COLUMN SPACING SEE
TABLES 2.1, 2.5, 4.1 OR 4.2
1/2"0 STEEL 0
BAR 0 18" w
LONG =
EE NOTE #7, SHEET 97GNO2.
SEE SCHEDULE FOR
FOOTING SIZE "d" = TYP.
CUBE SIZE
CI Y OF LA UUINTA DRAIN 1 1/2
BUI DING & SAFETY DEPT. $� 3 1/2" CONC. -d-
® PLACE 1— 1 /2"0X6"STL.
P P R BAR AS SHOWN
DATE
SEE SCHEDULE
FOR FOOTING SIZE.
7 HEADER
-INSTALL
COLUMN
PROVIDE 1 '1/2*
DRAIN
SPT EE NOTE • CONC. ON
SHEET 97G402.
PROVIDE 1 1
DRAIN
P P
INTERMED. BEAM
" STL.COL.TYP.
NSTALL CO
VERTICALLY f'=
I
MULTISPAN ATTACHED STRUCTURE
`COVER. P EL
MAXIMUM
OVERHANG
25X COLUMN W
SPACING =
SEE SCHEDULE FOR
FOOTING SIZE
SINGLE SPAN ATTACHED CANTILEVERED STRUCTURE
DATE REVISION DATE
�E
W Cm
_ NO. 6 0
E EERS STAMP
X1/2"0 STEEL BAR
0 6" LONG
SEE SCHEDULE FOR
FOOTING SIZE — "d"
IS TYP. CUBE SIZE
MEMNON
41
t.No
�-
OPT. 3 1/2" CONC.
SLAB—SEE
NOTE #5ON
SHEET 97GN02.
REVISION
Amer�imI
Engineering Services
1140 All Pro Drive
Elkhart. IN 46514 : E
KG ICBO ES EVALUATION REPORT NO. ER -2621P
t 04 NONE NAME STRUCTURAL CONFIGURATIONS ¢ -
I
2/8/2000 N tr 97SC01 1. 017.2 _ .. .