0310-309 (PAT)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:
( ) 1, 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 fhe 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 r+, w / /i
Signature of Owner c`�c.�_ 1na -fT
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 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 shat Dforthwith comply with ose�provisions.
Date: MU r%�/i ;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 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 representatives of this City to enter upon
the above-mentioned property for in tion purposes.
� S
Signature (Owner/Agent) �G� g /%'f' ate
BUILDING PERMIT PERMli
-
DATE VALUATION. LOT TRACT
JOB SITE
ADDRESS 54-"D AYMM+ A IdVE110
APN
-
OWNER
i
CONTRACTOR / DESIGNER / EN INFER
Aykn ' (XsOX
Cott R - B1111MER
54-900 AV f1=ARUB10
LA QIMTrA CA MM
USE OF PERMIT
PAM
44S.K PATIO COVER PER. CITY STA34DAAD WEST SIM! OF HOUSE
PC)k.CTYPA1110 44,00 OF
Es-r=A i) cosri.' will, Csisrw1'1`u(:I ON
St,a Sri 0
1?Tt"2.r.11 f FIEF GARY
K" CHECK FER 101.000.439.318 311.0
CONSTRUCTION FU 101-000418-000 1;17.00
STRO140 MOTION Me - RUSID :101.000-241-000 $150
RM -TOT'S , COPJ.rrt7LT , "IC w;,kbM PLA C` S7 -C,11
ug.3 t
r.; 33 PRE -PAW A793
50100
e TOTAL fi'1!='-MIT FEES DUE NOW
$28,55
OCT 2 9 2003
or- LA QuINTA
.iVv1
RECEIP pINANC _ * •
` �.
By ,(,
, G%'
DATE FINALED
INSPECTOR
/M -
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
Final
BLOCKWALL APPROVALS
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:
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 p:Qrty of record on.such a
permit. Building permits are not -required to be signed by property owners unless they are persanally 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 confitrn that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very trulyyours;
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78495 Calle Tampico
La Quinta, CA 92253
(760) X: (� 777-7012 /�j a
FA77Y1/011 /l /
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
RAFTER SIZE AND SPACING
ROOF P5H.
CONTINUOUS LEDGER
(SEE ROOFING NOTE ON REVERSE)
i
(SAME SIZE AS RAFTERS)
HEADER SIZE
-- -- _
�% ' 7-01
RAFTER SPAN: �1
Z
0. H.
I
z ,
-
O.M.
T Ar•A 'L' STRAPS
6"x6 �1�x1 /F WITH
c«r R sO�T
POST --
SPACING ----
I
I
-
OVERALL LENGTH: L
OVERALL -ENGTH
POST- SIZE--
(4'.4' MIN.)
RfmAR' SETBACK SIDE SETBACK
'FRdib� !
2000 P.S.1 CONCRETE =+1
L
I FINISH GRADE FINISH GRADE
JL—
_
J— M119. 12-x 12 FOOTING 1 I
IT.- BELOW GRADE L—J
PROVIDE 1" C RANCE
NEN P"�T`' RETE
OPEN I-ATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
INA ONE 1/4 x 5" LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
3/8 5" LAG SCREWS INTO STUDS AT 16" 0.C'.
CONTINUOUS LEDGER MKO
t/
IST HANGER JCING
I
I
I
i
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
L"zo
RUCTION
y
f '
U—STRAP OR' AN —
NON—CORROSIVE PLAT
(4)— 1i'NAILS�
ORB T , \
U—STRAP, OR ANGLE —
(4)— 16d NAILS
OR BOLT
'PROVIDE 1". CLEARANCE
BETWEEN,POST AND
CONCRETE
ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
GRPGE�
1
TYPICAL. PATIO COVER
DATE OF APPLICATION 1 11,Q Ali
ll
NAME OIJ�J
STREET ADDRESS S
CITY. ST ZIP Y MI
A 14 1
TELEPHONE
H.O.A. APPROVAL I
t
RAFTER SPAN TABLE
GrZ DING RULES r r p
RS 20-70
(FEET & INCHES)'
b r, it 7.
2x4
1 16" ^1".
1 '
HEADERS
-"
DOUGLAS FIR NO. 1
517= SPAN
i
I SIZ_& SPAN
j 4x-
4x4 4._0..
2x6
16" O.C.
24"
32" "
I
4x8. 8'-0.,
12'-6" 11'-6" 8'-9"
10'-6"
10'-0" 1 8'-e" 1 N/A I
N/A
6x a'-0"
10 i7'-0"
121-C:'
14.3
P.x
2x8
16" O.C.
24" "
32" "
18'-0"
17'-0"
13'-6"
16'-0"
t 5'- 6" '---6"j ?'-0" Il,
3'-0"
13'-0" t l'-6" I N/A
N/A
I I
NOTES:
1: 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED T.O 10'-0" USING
THIS STANDARD.
LAi i IC= ROOF
BUILT-UP ROOF
HEADERS
HEADERS
u0! SGL A=. FIR NO. 1
DOUGLAS FIR NO. 1
517= SPAN
i
I SIZ_& SPAN
j 4x-
4x4 4._0..
4x8. 1 ?'-0"
4x8. 8'-0.,
-4x10 14'-0"
4�xi0 10'-0"
4x12 1 7'-0"
4x12 I T-0"
6x a'-0"
10 i7'-0"
121-C:'
14.3
P.x
ALL CONSTRUCTION SHALL CONFORK
TO THE PROVISIONS OF THE:
2001 CALIFORNIA BUILDING CODE.
SUPPLE.MENTAL NOTES:
P00=1NG NOTES.
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: j %12 MAXIMUM PITCH.
1
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