0404-032 (RER)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:
()4° 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-fdrrothis reason
Date /7k,/ `✓ Signature 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:
Carrier Policy No.
(This. section need not be completed if the permit valuation is for $100.00 or less).
(k) I certify that in the performance of the work for wch this permit is issued,
1 shall not employ any person in any manner so a eto become subject to the
workers' compensation laws of California, and agree,that if I should become
subject to the workers' compensation�pri %dons of Section 3700 of the Labor
Code, I shall,forthwith comply with those rovlsions. X
Date: V/7 la , A plicant f i
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.rep(esent lives of this City to enter upon
the above-mentioned property for inspection urposes.
Signature (Owner/Ageitt) `i --� ... Date
PERMIT /t
BUILDING PERMIT
DATE
t� VALUATION LOT TRACT
-
JOB SITE
APN
ADDRESS1N. }A LA�°R4NZ
- -
OWNER
A
CONTRACTOR / DESIGNER / ENGINEER
LRM LOPL7
OWNER / nUrLJ).
52.105 .A'UENJDA CARRAN7A
Lh QtTA CA 92:53
( C BU
USE OF PERMIT
�:5=jWrDt..1'LEWODEL
2RO Sly I.1x° 7'7'€t:K PA110 COVER @ RM&R OF HOUSE PRR CITY
STANDARD, WINDOW CHA.NGSOUT @ DEDROOMS I.W AND KITCIM- 0(75
U -FACTOR). WATER HEATER CHANCEOUTI MISC. PL.ECTPUC 1,
PORCH€! ATIO 2$0.EI1) eI
VALUATION b,� �.OLt I's
MUMM. ) C 01ST Olid'" b OMMUC TION
11749)0.00
PIMA; FEE SUAW-ARY
PLAN C'HE'XX RE 101.00,0.439.318 $400
CONSTIZUCTIOIN FEE 101-000-415-000 $653.00
STittfi`10 MOTION YEE- RESID 101.000.241-000 x.50
M. EC'€`€t.1C.AL, Ir€w 101-000-420-000 $10.59
PLtJM)31N0 VerE 101-000.419.000 $22.50
Svc -TOTAL MIT&z RUCTIOX AND .PIAW CF1:f?.M
$146.45
LAS PR -PAID}MES
$0.00
UL PER! ; ! TMS DUE NOW
$ 46.+45
"02
_.may..
RECEIPT
DATE?J ) �-I
BY- _�
DF FINALED
INSPECTOR
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 C- U
Insulation
Compressor
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:
/
/�� 5--6> Z/ 14 `_
Final
:Jtility 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 Alio SPACING
ROOF PITCH
-- J
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING NOTE ON EVERSE)
&M
OPEN LATTICE PATIO COVERS MAY BE. ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' x 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
I BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
'FOR CONSTRUCTION
DATE `��Z"oy By
L
U -STRAP OR. ANGLE —
.NON—CORROSIVE
(4)- 16d NAILS
OR BOLT
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE 1' CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT. (EMBED —
7" MIN.. INTO CONCRETE)
,RPpE
TYPICAL PATIO COVER
DATE OF APPLICATION �/Z, Q
OWNER'S NAME • / �, Z
STREET ADDRESS f2 OS
S
CITY. ST ZIP qZL'
TELEPHONE 1 /_ 9 o,3
H.O./_ APPROVAL
`-- CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
/(� �)
T AND 'L' STRAPS
HEADER SIZE
I f
Irtca1'a1/8, WITH
W
=
(s) 16d NAILS OR BOLT
(� lI
1
z
R AFTER SPAN: -1
POST SPACING: ` o
O.M. O.M.
I
OVERALL LENGTH:
)
OVERALL LENGTH_ __
2
POST SIZE: w
REAR SETBACK SIDE SETBACK
(Awc NIH')
177t
FINISH GRADE FINISH GRADE
2000 P.S.I CONCRETE --+1 I I
6— MIN. 12' x l T FOOTING I I
L - .J I L_
4.
J 12' BELOW GRADE L__J
PROVIDE 1' CLEARANCE
BETWEEN POST AND
CONCRETE --1
&M
OPEN LATTICE PATIO COVERS MAY BE. ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' x 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
I BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
'FOR CONSTRUCTION
DATE `��Z"oy By
L
U -STRAP OR. ANGLE —
.NON—CORROSIVE
(4)- 16d NAILS
OR BOLT
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE 1' CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT. (EMBED —
7" MIN.. INTO CONCRETE)
,RPpE
TYPICAL PATIO COVER
DATE OF APPLICATION �/Z, Q
OWNER'S NAME • / �, Z
STREET ADDRESS f2 OS
S
CITY. ST ZIP qZL'
TELEPHONE 1 /_ 9 o,3
H.O./_ APPROVAL
RAFTER SPAN TABLE
GRADING RULES S� S� v
PS 20-70 V V v
(FEET & INCHES) OOJ�y OOJ�� 40JA�? OQ
2x4
16" O.C.
24" ".
10'-6"
1 9'-6"
i 7'-3"
8'-9"
8'-6" -0" 6'-0"
7'-3"
DOUGLAS FIR
N.O. t
2x6
16" O.C.
24'- -- -
32" "
15'-0"
14'-0"
10'-9'
13'-0"
12'-6" 11'-6" 8'-9"
10'-6"
10'-6" 8'-6" 1 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" 1 1'-0" 113'-0"
13'-0" 11'4" 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 DOUG!A=
FIR NO. 1
DOUGLAS FIR
N.O. t
S17 -
SPAN
SIZE
SPAN
4x.4
5'-0"
4x4
4'-n"
4x6
8'-0"
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
4x10
14'-0"
4x 10
10'-0"
4x12
17'-0"
4x12
12'-0"
6x8
14'=0"
6x8
12'-G"
6x10
17'-0"
600
1 4'-0"
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE:
a60/ CALIFORNIA BUILDING CODE.
SUPPLEMENTAL NOTES:
POOFiNG NOTES:
A. BUILT-UP. ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
i
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 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 ANDrS.ETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777- 012
FAX:�f jj7-7 11
OWNER'S SIGNATURE/ DATE
57_L1/6)_ k641r&AIZ-1e�
PROPERTY ADDRESS
PERMIT NUMBER(s)