COMB (0207-021) + PLBG (9428)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjL y 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:
(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). 41,
() I am exempt under Section B!&PIC ,for this reason
;
Date `it R tilt ni e� Sianature of Owner . "
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:
Cartier 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 s all not employ any, person in any manners as to become subject to the
workers' compensation laws of California, and ��,gree that if I should become
subject to the workers' compensation rovislons�Section 3700 of the Labor
Code, I s II fo hwith comply with'thos p�o ,io
Date: Ap licant +
Ro r
Warning: F i to secure Wo kers'.Gompensatio coverage is unlawful and
shall subject an employer to criminal penalties anvil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject, to the conditions and restrictions set forth on his
application. '
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, Its officers, agents and employees.
2. Any permit Issued as a result of this application becomes null and Vold if
work is not commenced within 180 days from date of Issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation,
I certify that I have read this application and state that the above Information Is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo Insp'ection urposas.
Signature (Owner/Agent)( t,41`9 Date 3161
BUILDING PERMITS
,�%',PERMIT#
CD`�07-!'R21 1
DATE VALUATIONm� LOT TRACT
JOB SITE ADDRESS `.r1a�-F 30 A Y.4:MDA 67ffA4"d (.)Z,n7.
APN .. -
OWNER
CONTRACTOR /DESIGNER /EN (NEER
pEOIYyM HUMS
`MBUILDFIZ
L k(`aUI fit`s CA. 9221,E
USE OF PERMIT
135 L1Y R . ','Y"AWO 6' WOOD FEWIF, 1tVDI t'1014 CIF ONE ?O.min
DRE"0 111:1$ wk' LATTift PATIO GOWIt PER 0 -TY STANDARD &
VLhtr43•rd.TIO4 BUD 1.4
'S
6 FT. FOOD FFCE 135.01 11F
�
ifaORCH/pA T IO -43100 'CI
CONSTRUCTION FES; 101-•000-418 000 �G3.ds0
F3.itif,".'E'T�Ci"•t.I.l�I:�.F, z 7 i3•�C)(3f)�'�•$��f�t?0 dl�:fttt
S�1iRONOWAO 1014 Ya �::i:stp I.01 -000-241-0£i0 �.§0
�L)
?111' :CIYfLAQUINTA
ff---O
EINANCEDEPT.
y�7� ��qr, Ay /��,•�er��y .�{�y*y- ��yyy C _ A p r.T �^
,8VI.7-�ya1l3.P�£�i�A.s'i M-114a41J,r�0 ,2`WD .frKM�"!1%O R.J Y_4X::':
�.¢ r} �1
$12,2.43
$12, +.43
RECEIPT
DAT
DATE FINALED
INSPECTOR
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
U IYZ —
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Footings
Bond Beam
_
l� _� -
/
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
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/ 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 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 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 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 State
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
La Qui a, CA 92253
( 12
OkqjEf GNATURE/DATE
41tLA�
PROPERTY ADDRESS
o2n7--off
PERMIT NUMBER(s)
E
RAFTER SIZE AND SPACING
ROOF PITCH
_ – – – ® – –
SPECIFY ROOFING AND SHEATHING OR )DEN LATTICE --
(SEE ROOFING NOTE ON REVERSEI
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4•' x S' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
3/8- x 5" LAG SCREWS INTO STUDS AT 16" O.C.
f— CONTINUOUS LEDGER
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
I
x,S 41 , P,+no a Ube
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCT N
DA �30 BY
C// ! f L, 2c—
11
U -STRAP OR ANI
NON -CORROSIVE
(4)- 16d NAILS
OR BOLT
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
RASE_ •
N
ANCHOR BOLT (EMBED
7" MIN. INTO. CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
7-3 -� L
OWNER'S NAME e",
STREET ADDRESS
CITY. ST ZIP
TELEPHONE
H.O.A. APPROVAL I ;&/ / �
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
U `
HEADER SIZE
T AND 'L' STRAoS
–,`�--
TH.1
6'x6*0"xi/S" WITH
2
4) 16C NAILS OF BOL(
RAFTER SPAN;___
2__
J
POS' SPACING:O.H. --
r
a
OVERALL LENGTH:
(L
Q.
OVERALL LENGTH.__1______
POST SIZE.____
REAR SETBACK SIDE SETBACK
(4"x4' MIN.)
2000 P.S.I CONCRETE FINISH GRADE FINISH GRADE
I � MIN. 12'• x 1 2" FOOTING I I
- 12" BELOW GRADE L _ �
PROVIDE 1" CLEARANCE
BETWEEN POST AND
NOTE CONCRETE --�
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4•' x S' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
3/8- x 5" LAG SCREWS INTO STUDS AT 16" O.C.
f— CONTINUOUS LEDGER
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
I
x,S 41 , P,+no a Ube
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCT N
DA �30 BY
C// ! f L, 2c—
11
U -STRAP OR ANI
NON -CORROSIVE
(4)- 16d NAILS
OR BOLT
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
RASE_ •
N
ANCHOR BOLT (EMBED
7" MIN. INTO. CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
7-3 -� L
OWNER'S NAME e",
STREET ADDRESS
CITY. ST ZIP
TELEPHONE
H.O.A. APPROVAL I ;&/ / �
RAFTER SPAN TABLE�� OCA
GRADING RULES i c Co /� �/ � `� '�`� j ALL CONSTRUCTION SHALL CONFORM
PS 20-70 ov �; ov �!�i� i TO THE PROVISIONS OF THE:
.(FEET & INCHES) pJ'�
i 1998 CALIFORNIA BUILDING CODE.
o'��i
•z:,z1,�� ze
p / SUPPLFMFNT4i Nc-)TFc
1
10' 0. C.
24
10'-6" I
9'-6"
T-3"
8'-9"
FIR NO. 1
DOUGLAS
FIR NO. 1
1 SIZE
2x6
Ij I
f
16" O.C.
24"
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
6'-0..
4x8
11'-0"
16" 0. C.
24"
32" "
18-0"
17'-0"
13'-6"
16'-0"
15'-6" 14'-6" 11'-0"
13'-0"
13'-0" 11'-6" N/A
N A
12'— 0"
6x8
NOTES:
j 1. 32" RAFTER SPACING IS ALLOWABLE
I FOR OPEN LATTICE PATIO COVERS ONLY.
I
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED TO 10'-0" USING
THIS STANDARD.
LATTICE
ROOF
BUILT—UP ROOF
HEADERS
HEADERS
DOUGLAS
I
FIR NO. 1
DOUGLAS
FIR NO. 1
1 SIZE
SPAN
SIZE
SPAN
4;.4
5'-0"
4x4
4,_0..
4x6
8'-0"
4x6
6'-0..
4x8
11'-0"
4x8
8'-0"
4x 10
400 O
10'—O"
4x`12
17'— 0"
4x 12
12'— 0"
6x8
14'-0"
6x8
1
6x10
17'-0"
6x10
14'-0"
ROOFING NOTES:
A. BUILT—UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12.MAXIMUM PITCH.
e
e
, Y
e
hI r NI o U p
42 WP - No. R";sion/N.u. - Dot.
LL
11 L rd'S. BuDtos
_
r 44-840 -Se ly r.
Ojf Z LA OUINTA, CA. 92253LL `
O -Z �.'U PM. (760) 345-2877
I_ ( n M FX. (760) 345-2685
CL. (760)
578-8480
Um Q Parcel # 774-063-007
Legal Description
Lot 18
BLK 206 MB 019/038
— / f.� / Detail ;� Santo Cnrneuta Vale
N '(. La Ouin3a Unit ' 20
"°'"Remodel
3/4
�-
N.T.S.
p
L
-
.E
.:
a -J
hI r NI o U p
42 WP - No. R";sion/N.u. - Dot.
LL
11 L rd'S. BuDtos
_
r 44-840 -Se ly r.
Ojf Z LA OUINTA, CA. 92253LL `
O -Z �.'U PM. (760) 345-2877
I_ ( n M FX. (760) 345-2685
CL. (760)
578-8480
Um Q Parcel # 774-063-007
Legal Description
Lot 18
BLK 206 MB 019/038
— / f.� / Detail ;� Santo Cnrneuta Vale
N '(. La Ouin3a Unit ' 20
"°'"Remodel
3/4
�-
N.T.S.
Building 537130 Mendoza
Address
Owner
Eugene C. Ferry
Mailing
Address F.0- box 1024
City Zip
San j8an "ap.iLc trano
owner % S1
Address -
�CV L
P.O. BOX 1504 No. 9428,
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
92 g' 7141728-0247 Legal Description
Project Description -,Sewer Boots UP,
' City
Zip
Tel.:
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size •-
Stories Units
Arch., Engr., -
New ❑ Add ❑
Alter ❑ Repair ❑ ' -Demolition ❑
Designer
Address
Tel.
City
Zip
State'
'
Lic. #
LICENSED CONTRACTOR'S DECLARATION
7' —
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
::.effect.
,
'
"•.� SIGNATURE - DATE
OWNER•BUILDERDECLARATION '
` I hereby affirm that I am exempt from the Contractor's License Law for the following-
=^'reason: (Sec.' 703 1.5, Business and Professions Code: Any city or county which the,
a
;, permit to. construct, atter, improve, demolish, or repair any structure, prior to Its issuance also
,requires the applicant. for such permit to file a signed statement. that. he is licensed pursuant. to
` .the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
` Division 3 of the Business and. Professions Code, or thathe 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 live hundred dollars.($500). • •
' 611, 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, Buisness and
• Professions Code: The Contractor's License Law does not apply to an owner of property who
T builds or Improves thereon and who does such work himself or through .his own employees,-
F provided. that' such improvements are not intended or offered. for sale. If, however, the building
or improvement is sold within'one year of completion, the owner -builder will have the burden
-., of proving that he did not build or Improve for the purpose of sale.) -
Estimated Valuation
PERMIT '
AMOUNT
Plan Chk. Dep.
'
Plan Chk. Bal.
-
Const.*,
-Mach.
"• Electrical
.'
Plumbing
Ju VU
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
I struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License -Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projectswitha contractor(s) licensed pursuant to the Contractor's License. Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason i
�;• rs'
S.M.I.-
Grading
Driveway Enc.
Date?Towner.x"�/J.eg �' d'
Infrastructure
"
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that l have a certificate of consent to self -insure, or.a certificate of -
., Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code:)
"
Policy NO. Company
❑ Copy is filed with the city. 0. Certified copy is hereby. furnished. ' `
' `"' ""' •'�'� 'a ' i x"R raP F.� P03 2 PE ?%A t'
TOTAL
CERTIFICATE OF EXEMPTION FROM •' f'
u ..: WORKERS' COMPENSATION INSURANCE
REMARKS•.
or less.section need notbe completed if the permit is for one hundred dollars (8100) valuation
I certify that in the performance of the work for which this permiLis issued; I'shall not
employ any pperson in any manner so as:to become subject to the.Woikers' Compensation,
Laws af,C3lifd,�ni
DateOwner..�✓" �7
NOTICE TO APPLICANT: If"aBer'7imaking this' Certificate of Exemption you shyyud' become -
subject to the Workers"Compensation provisloris of the Labor. Code, you�rhusf forthwith
comply with such provisions or this permit shall be deemed revoked. //
_
ZONE:' - - 'BY:
Minimum Setback Distances: . -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
r' Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil code.), • ..
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR,
y'
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
ti expiration if work thereunder is suspended for 180 days.
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
construction, and hereby authorize representatives of this city to enter theabove-.
mentioned property for inspection purposes.
Issued by:
t
Validated by:
Date - Permit
Signature of applicant Date
Mailing Address
Validation:
-
City, Slate, Zip "
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO, FT_ ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® Vbc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
I
i¢
,/$
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINMALS
GARDEN WALL FINAL
Account No. �4' S ' v • Lot(s) ". Tracts u
Service Address �: �-> �% rf\ef- c G.A. Coded
❑ Meter(s) s k $
❑ Service(s) i
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge —t
&,Sanitation Capacity Charge EIS S 1, Chi
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL
Remarks:
❑Copy to:
Cash Water Service
Check 1
Money Cashier
Order CVWD-438 (11/89)