0003-213 (PAT)LICENSED CONTRACTOR DECLARATION
I :hereby : ffirm under penalty of perjury that I am licensed under provisions of
IthApter 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:
,Q,- 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
�to � Z77242nSignature of Owner_ -4__7;'.., . "/f S/-1�i
— r 5i
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).
(a�) I certify that in the performance of the work for which this permit is issued,
I shall not erri'ploy''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.-9T'.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 inspection purposes.
SSiign to ure (Owner/Agent)' 7- 17 - 0 Q Date i
Y i'tnR.'Ct,SCO J. v,5
PERMIT #
BUILDING PERMITt6913-'Z:r1,3 = r
DATE VALUATION �/'�-,41 LOT TRACT
JOB SITE
ADDRESS 51-305 AVir1 IDA
APN _
i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r. �y n n.�r�rrrn t n.tnr u���� t n
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ntcrnir 0110i Iri' T1i:i?
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51-305AV.i~N.1DAELW.1REZ
5€-305AVENWAItr't,iMI UZ
LA QUINTA. CA 92753
L.A OUIWA CA 02253
USE OF PERMIT
U>rNRicAL Etlif-LDQ46
N%T10 i 2LF X 4 -5i64 SQ. Fs.
po[� Ck•'IIPXJ"10 51G.(k1 ST
PERMH* FEE SUMMARY
PLAN C.I• FkX F& 101-000-439-318
C•ONSTIRI IrT10N F FST'. !(11 4)M-41 9_(1(.U)
`::I'R'01401440TION FFJ_ .137.SID 101 -000
SUB-'MTAL ('ONSIMLIC" noN AND PLAN C;MUC':K
$!4q.!9
LrSa n1i1.,_ :;IJ FF.?1+:w9
0.^I1
1'0TA1.P11eKNI11' 141, CIS 1)U1-t:NOW
$149.19
RECEIPT
DATE
BY -
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
Ce— S7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
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:
�7
rI
ce4t,/ 4 Q",
Dear Property Owner:
78-495 CALLE'TAMPICO LA QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012' FAX (760) 777-7011
OWNER/ BUILDER. INFORMATION
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 tube licensed and bonded by the State of California and to have,a.,bus.iness license
from the City or County. They are also required by law to put their licensenumber on all permits for which they
apply. S
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.insurahce 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 unde'r.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, orE,through':their'own employees; without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing, to.be.contractor s 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 .nor required, to be signed by property owners unless they are performing 'their own work
personally.
Information about licensed contractors may obtained by.conta'ting the.Contraciors' 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 buildingpermit will not be'issued`until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
`— 78-495 Calle Tarinpico
La Quinti, CA 92253
(760)777-7012
FAX (760) 777-7,011-x;,
O ER'S SIGN RE/DATE
PROPERTY ADDRESS
Doo3 -
PERMIT NUMBER(s)
RAFTER.' SIZE `AND SPADING a SPECIFY ROQRNG. ANO'.SMEATHING R' OPEN LATTICE —.
F, (SEE ROOFING NOTE ON REVERSE),
ROOF PITCH r s „ . • .. • •
CONTINUOUSI LEDGER <. tIrU
,l (SAME SIZE AS RAFTERS) I I
HEADER SIZE t I I T, ANDL'44STRAPS
WrTk
z ?"' �.'.(4) 16e NAILS OR BOLT Ii al 1
POS'. SPACING: / I:
/ RAFTEP. SPAN:/
J O:H.
Ml
: ' 'I
2io Q OVERALL'LENGTH: f9
.ONGTr
I
POST SIZE: _ I tol
(4"x4' 'MIN.)
SEI
/' REAR TBACK {. SIDEr.'SETBACK.;.
FINISH GRADE y FINISHGRADEI MIN. l Z'x.12' FOOTING I I
2000.P.S.I CONCRETE — I L_J 1'2' BELOW.';GRADE L -J
I ,t I
PROVIDE l" CLEARANCE
BETWEEN POST AND
„ CONCRETE
NOTEa
OPEN LATTICE PATIO COVERS - MAY BE ATTACHED TO • EXISTING FASCIAa
• VIA ONE 1/4- x S' LAG SCREW THROUGH FASCIA"INTO EACH RAFTED TAIL. * -
U—STRAP OR'rANGLE
NON' -CORROSIVE PLATE RP(lE
—3/6' 5' LAG,SCREWS.INTO STUDS AT 16' D.C.--i G
�- CONTINUOUS. LEDGER " 1 I I #'
1t! j.l (4)- 1:6d NAILS
�YY: ��. I. I �• ,I:;,I OR .BOLT
` LI -STRAP OR -ANGLE
(4)= 16d. NAILS
OR" BOLT
i
JOIST HANGER OR SOLID BLOCKING " 2
NAIL RAF,EP TO BLOCKING PROVIDE, 1" CLEARANCE
! BETWEEN;=POST, AND
CONCRETE .
BUILDING DEPARTMENT, *APPR:OVAL BEL'OW`II II
i
ANCHOR .BOLT ,'(EMBED.,
7" MIN. INTO CONCRETE)
CITY OF LA-QUINTAr' i.
BUILDING & SAFETY DE�P,T. TYPICAL PATIO COVER
APPROVE, DATE OF, APPLICATION
fOR CONSTRUCT ON rt OWNER'S NAME '/%>� �Q G�.•te�
STREET ADDRESS5°�%-
DATE ZIlLk BY,r` crTY: sTr fZIP. "'�" --•- —
i TELEPHONE 771%
H.OA. APPROVAL ;