0301-335 (PAT)79770 America Ct
0301-335
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
f*.
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:
(y ) 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).
Q I am exempt under Section B&P.C. for Uiis reasoA
Date Signature of Owner!./ - i f
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 this 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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: !. y 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 fortb 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 upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent), ..= -r ' f %' Date
BUILDING .PERMIT PERMIT#
cax
DATE VALUATION 1 LOT TRACT
JOBSITE `
APN
p y.y y
ADDRESS CA CC)IUAQ..l+
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Ai....diSt. S-al
01hrb ..di ' BU11', IU' E,
6401 140111,RKNI.I' OAD tEl
p1+Tmolm 111711'1 CA
USE OF.PERMIT
1 xf..10
540&0r. i A'f"1'oC t A1 SO G't:iL PDt, t3k;R9?P1:0'Ji] FaJ.A1d:»7'IiLtCTR!$2AEr
CA
PORt'Yl .P.&TY0 r10.0^^, 811
XYPY7f1!, A1*113) COSTOF CONS"I?RU MON
70,92,D0
PLAN CH)KCK FU 101.000.439.510 964.35
CON IST R UC1` 0114 tr'n,l" 101-000-4-M000 09,00
IM10140 MOTIOW ME - SID 101-000-M-000
;31M-'x"UrAL E..t?MSiRi3M1.014 .E►.ND 1'1.M C..i3.1:Cxxt
$163.W
,YYA,L ,7?7.;T?M1 F11.'S DDR POW
&164.017
JAN 2 9 2003
CITY OF LA QUINTA
111 IN 60
FINANCE DEPT ,
IE
i
RECEIPT
DATE 1 e
BY •.`-•ti
DAT FINAL
INSPECTOR
s i 7 ulf. 3
e
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.
Framingp
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Finalo
BLOCKWALL AP ROVALS
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:
el
61
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B 0 B H 0 F F M A N: Stnictural Fngmeer
A 2' 57>-_ -9 i5-4> 17.e -,5z, —,/W= 16403
------ 7-/.. 71o6
Z/
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TY fAl
'•...0IOF LAQUI z 26,c r60p,
E ; JILDING & SAFETY DEPT.
`5 0
FOR CONSTRUCTION
DATE o BY
-p f
............
Six Alfaro Drive, Rancho Mirage 92270-4758
Tel/ Fax (760) 568-2967 (760) 773-3797 (w/ P -mate)
wbert-hoffimanowebWnet 690C)t>- C>-,
B O B H O F F M A N, Structural .Engineer
oe
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Alf
B y y 9
A2 OgL _ ---- - _--_— - ---------- ----
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17
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7/2''
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- x 4 Installation
V y
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LU
dw= as
Six Alfm Drive, Rancho Mirage 92170-4758 \ a
Tel/ Fax (760) 568-2967 (760) 773-3797 (w / p'male) 1
wbert Koffman bTV.n t W*'03 — 07
LCB _„_.
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rl
01/20/2003 04:54 12
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01 ,
AlY E. IRI$
CERTIFIED PUBLIC ACC.OU TANT
CERTIFIED GENERAL APP ISER
6401 NOHL CHf91869
OAD
ANAHEIMC
ce714-685-8535 fax: 714-688541
A rish9000 QndC,
z
I
TO: Bob Hoffman
PAGE I OF 2
FROM: AL IRISH
SUBJECT: Double Beam en ineerin f
r Patio
COMMENT: Bob you were referred by
nis Wish. City of La Qi
does not have a standard for a double bea
patio, which I wish to bu
79770 America Ct. in La Quinta. Slab has
een poured with post alai
Building permit issued only for the single b
am area as per attached
map. I need engineering for the rounded a
a of patio with the two
beams. Thoughts are for 4x4 posts, with 4
2 beams, 4x6 joists, care
31Wb inch 4x8 sheets of white plastic lattice
, ofing for 50% shade an
let wind pass through.
Should there be questions please call 714-6
0-8535 and let me know
to send check for your services. Thanks
Al Irish
REPLY:
at
to
e
PAGE 02
01/20/2003 04:54 12
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LA QUINT-
StiLDtNG
APPROVED
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-761-770 G' '.
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01/.20/2003 04:54 12
• RAr1ER
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Poor Pacts
/,
CO&ONUOUS LEDGER )
RArTEu $PAM•
2000 P.S.i CONCRETE I`- J
PAGE 03
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(SEE ROOF
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OPEN L I PAS LAG C&ASC,," TMR uG rASCICHED & uwTO EAC" RARER TWL.
11,CU-STRAP OR ANGLE
3/d' . 5 LAC SCREWS MIO STUDS AT 16' O.C. NON -CORROSIVE PLATE e
CONTINUOUS LEDGER
II I I
I(4) - 16d NAILS
OR BOLT
u—STRAP OR ANGLE
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I OR BOLT
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PROVIDE 1" CLEARANCE
NAS RArTErt To BLOCKINGPROVIDE
POST AND
CONCRETE , I I
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA OUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
I
ANCHOR BOLT (EMBED —
'r M1N. INTO CONCRETE)
TYPICAL PATIOOVER _
GATE Or APPL.ICAnow , 403
O e•S /QL ! l.r 111
T A 777100 *eRk cn
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TELEPHONE J p/
N.O.A. APPROVAL
A1111111
11111 1111 62
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YOUNG ENGINEERING SERVICES
Engineering Architecture•Surveying• Building & Safety Services
Letter of Transmittal
To: CITY e'er 1-.2 ewe t9''». Date:
Project:
Attn: W.O.:
Tel No.: Tract No.:
We are forwarding:
No. of Copies
(.
By Messenger By Mail Your Pickup
Description:
I.- AN -
Comments: }y2
This Mdterial Sent for:
Your Files Per Your Request
Your Review Approval
Checking At the request of:
Other
By:
Phone #
77-804 Wildcat Drive, Palm Desert, CA 92211 (760) 360-5770
Bronz Young
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a 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/ 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 performed by someone other than yourself, 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 variuus 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 an employer.
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 State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation 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 Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare
Law, contact the Department of Benefit Payments and the 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, without a licensed contractor 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 providing 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 verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
LaQuinta, 92253
(7I 777 0 2
FAX: -701
OWNER'S SIGNATURE/DATE
r7).9
PROPERTY ADDRESS
032/-V3,
PERMIT NUMBER(s)
IIIIIII
VIII
III
VIII
IIII 63
IE
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a 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/ 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 performed by someone other than yourself, 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 variuus 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 an employer.
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 State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation 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 Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare
Law, contact the Department of Benefit Payments and the 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, without a licensed contractor 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 providing 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 verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
LaQuinta, 92253
(7I 777 0 2
FAX: -701
OWNER'S SIGNATURE/DATE
r7).9
PROPERTY ADDRESS
032/-V3,
PERMIT NUMBER(s)