9706-157 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjurythat I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and ioy..Liceno 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 am exempt under Section B&P.C. for this reason '
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION • .
I hereby affirm under penalty of perjury one of the following declarations:
J ) 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. . 4
Date:' %: 7i Applican`
,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 a's 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 t~
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)••- ���� �f"'�i /t Date
BUILDING PERMIT PERMIT# CONTROL#
7 5423
970
DATE VALUATION LOT . TRACT
02
JOB SITE A�
ADDRESS %9-275 S�iC. RI A'1, i'Ei,LA'4 CIC:.
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
tai :A'13.ClS TOWN
OWNER BUILDER
73-2751.01RIZ :)N PALM CIC.
LA, QUINA CA 9MI
USE OF PERMIT
ry�.p 5-F ' L-ATIGC. -fAT10 44VC'F-°
MST41M� TED COST Oft WNSTIKUC i'alON
1,59v.00
PLAfd CRECK PT -1, 101-00 0-439-318 S t.fa5
101, -OW -418-000
VON , MV17101.4 t3. RES10 . I.Qt-i3 tJ 2G�I-fJUD .
t
CON 9PRUCTrION D PLAN CHE'CK
1, _0
,;SUN 2 7.1997
TOTAL Mtt1Iff FFF'S 11.) ;NOW
.X
RECEIPT
DATE "BY 4
DATE FINALED
INSPECTOR
_
L1
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
Compressor
Insulation
Vents
F41face P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWALL APPROVAI S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
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
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
t
---
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING TE REVERSE)
—�-----------------
ROOF PITH
-CO INUOUS LEDGER ,
(SA ESIZE AS RAFTERS)
HEADER ! dZE G
— — — z
aoZ
OVERALL LENGTH: -------- 1— a ,,
I 'T' AND 'L' STRAPS
6"x6"x1"xl/8" WITH
I (4) 16d NAILS OR BOLT
POST SPACING:
OVERALL LENGTH:_ �__
I z
a
w------ U
/
POST SIZE: --- X
REAR SETBACK SIDE SETBACK (4"x4" MIN.)
__ N
2000 P.S.I CONCRETE FINISH GRADE FINISH GRADE I MIN. 12"x12" FOOTING
L_J L 12" BELOW GRADE
I I
L
PROVIDE 1"
CLEARANCE
BETWEEN
POST AND
NOTE: -
CONCRETE
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" x 5" LAG SCREWS INTO STUDS AT 16" D.C.
NON—CORROSIVE PLATE
CONTINUOUS LEDGER
II
II II
(4)- 16d NAILS
RPpE
��II15H
II
III II
..
JF
OR BOLT
U—STRAP OR ANGLE
.(4)7 16d NAILS
OR BOLT
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO1 BLOCKING
PROVIDE 1" CLEARANCE
BETWEEN
CONCRETE AND
II
-.,
BULLDING DEPARTMENT AP OVAL BELOW
II II
II III
II II
III II
Gl-
l`� � ' .-s
WON
ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
ACCEPTED FO'
TYPICAL PATIO
COVER
GATE OF APPLICATION
1,
OWNER'S NAME
STREET ADDRESS
_._
AND ALL APPLICABLE IDBS
CITY, ST ZIP
TELEPHONE
(�
�!Y
H.O.A. APPROVAL
v Q-
RAFTER SPAN TABLE
GRADING RULES
PS 20-70 psi psi j
(FEET & INCHES) 0��A!� OpJ K,OpJ�� j,per � ,per ,per v p�
O
NOTE:
32" O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY.
LATTICE
ROOF
BUILT-UP
ROOF
HEADERS
HEADERS
DOUGLAS
FIR NO. 1
DOUGLAS FIR
NO. 1
SIZE
SPAN
1
1 •
4x4
�� : •lam
1
4'-0"
4x6
8'-0"
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
4x10 P<,14'-0"
400
10'-0"
402
17'-0"
402
12'-0"
NOTE:
32" O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY.
LATTICE
ROOF
BUILT-UP
ROOF
HEADERS
HEADERS
DOUGLAS
FIR NO. 1
DOUGLAS FIR
NO. 1
SIZE
SPAN
SIZE
SPAN
4x4
5'-0"
4x4
4'-0"
4x6
8'-0"
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
4x10 P<,14'-0"
400
10'-0"
402
17'-0"
402
12'-0"
6x8
14'-0"
6x8
12'-0"
6x10
17'-0"
6x10
14'-0"
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE 1994
UNIFORM 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:
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,
- -- _- J CITY OF LA QUINTA-
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
F (760) 777-7011...
OWNER'S SIGNATURE/DATE
n
PROPERTY ADDRESS
PERMIT NUMBER(s)
06/27/97 13:30 FAX 619 862 1210. LEWIS-POLE & ASC 0 003
FROM Torrance High School Library
co
LM
03/29/97 15;16 TX/RX NO.S247 P.001 0
06/27/97 13:30 FAX 619 862 1210 LEWIS-POLK & ASC
ARCHITECTURAL REVIEW COMMITTEE USE ONLY
The Architectural Improvement Application. was reviewed -by the
Architectural:Committee on. and has been:
Approved ConditionallyApproved Rejected
subject to the following
conditions set forth below
Returned for Further Information
Required Modifications
Comments
IDa Architectural Committee
OA'rch Wec ra ommittee Architectural Committee
Architectural Committee Architectural Committee
NOTE: THIS APPROVAL IS VALID FOR 90 DAYS FROM APPROVAL DATE
Q002
s
06/27/97 13:30 FAX 619 862 1210 LEWIS-POLK & ASC
LA QUINTA PALMS
HOMEOWNERS ASSOCIATION
APPLICATION FOR ARC HITECTURAL.9PPROV,AL
NAME(S)
PROPERTY ADDRESS 7 '�-
MAILING ADDRESS
Print) ,ii/00
Lotr: /J 7
LOCAL PHONE - OTHER PHONE
REQUESTED IMPROVEMENT `� Q. i,{) l",(�..t cQJi rA-1 0 t -1--t-1 _Xe .�
I have attached three (3) copies of the proposed architectural
improvement or variance (not applicable for pre -approved items).
I understand that I must allow up to 30 days for a formal reply
from the A.R.C. prior to commencing with any work. The Committee
is not responsible for the structural integrity of said
improvement. The work shall meet or exceed the local, county,
and state code requirements, and I agree to obtain all necessary
permits accordingly.
Owuer(s) Signature: Date:
NEED BOARD ACTION
f_LV
Rev. 5-96
Q001