9610-085 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 700.0) of Division 3 of the Business and
Professionals Code, and my LiceM1e is call force and effect. A
License # Lic. Class Exp, Date
b
/a '4 a
UDate 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 nwnP..r 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:
( ) 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:is Oft; My)%Wdrkers' compensation insurance cdr?.i'6*&: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! ;o become subject to the
workers' compensation laws of California, aqd agree) that if I shoul�� become
subject to the workers' compensation provisions of Section 3700 of he Labor
`ode, I shall fo with comply with th,X a prov� iofis.,
Date: iu 7-G 4 Applicant A k'-- -i
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimi / I penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section'3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or. pursuant to .
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 18.0 days will subject permit to cancellation.
I certify that I have read this application and state that the above information, is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of:thi°s City to enter upon
the above-mentioned property for insp'Ct .. pu pose .
Signature (Owner/Agent) ;ate r/
BUILDING PERMIT PERMIT# CONTROL#
�����4►.�►��
DATE t�I'/iy�F/ m VALUATION "t)f9. Il LOT TRACT 4 2 61
JOB SITE
ADDRESS 54-%40A'k%NJ0A R/t►MIRIL Z APN 173.323-60.5
OWNER CONTRACTOR/DESIGNER/ENGINEER
ldi'; W. S'(•r;a'f'i'IR rat. 00,11-4ST
'R t) A �%: 1�.1.0 ti .kt A3►3.C)'tL 7; 42335- WA. SkIING 1,3N SL 1855
I.a\ QUINTt4 t:'A 9212 3 P/h[,P+3 op.st-acr CA 42 260
(61U.!y)i()-fnCi$ 001`10 21 t>
USE OF PERMIT
NA'.1'io
1. Al 71CF iF'ATI 0 C;0VER.
PC. tt > u,t''
$17
("OST OF CC?1mfSIRi1' 'A"10N 1,396-50
PERM -1.11* VFW SUMMARY
PLAN CFIF("K.FE Y)! -('(N. 43()-3JX S2,I A _5
CONIS' R;JCTIC?XMT 101-U()o-41$-000 533.01?
ST01,4% 1%,i:C?TIOrd it k. - RM -SP) 1.01-000-241-060 $.so
'*. "Of- l C0 ,"tR=ffON AND PLAN CMICK $5.1-95
D LESS P2L;-PA,ID FIRES WOO
OCT 2 9.1996 '
pf 1�, �'837119ft�' kH #t�S �)t;�;i°tt"��V' $54.95
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION j
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
Instation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Parr Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final'
BLOCKWALL P OVALS
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:
,
DA'
RAFTER E � �PI�gpIG
. 171=—
.
ROOF` �RCM� -
CONIINKM LMM
HC
41
RAFTER SPAN: 64.
OVERALL tENCTN:
�1
W
V /
TBACK ' SIO!
/.T mo
2000 P.S.i CONCRETE J • ••••.•.• ••_.1E FAN._..—
LJ I
C,
ONE R11/C4 S LAC SCREW
PATIO
FASCIA
FFAFASCIAKM EACH
VIA RAFTER TAIL U -STRAP OR AN
NON-OORR04NE
3/ir 11 S LAG SC mws wm snm AT 1 S O.C. ~
CONTMAJOUS LEDGM
eTa MILS
M
SPECIFY ROOFING NO SNEATNNNG OR OPEN LATTICE
(SEE iROOFMG NOTE ON REVERSE)
--- � tl �---------
t AND v STRAPS —
drnSSl*ut 1Y wn
(4) 1d0 NALS OR BOL/T
_ +•%1
MI. SxS POSTS
MIN. t 2':t t FOOTMIO
1 T BMW CRAM
PRO'VOE t' CLEARANCE
80%M POST AMO
Ll --STRAP, OR ANOL[
at BOL1•dT. NAL! —
Olt
..........
F LA
CITY \. 4
- . r i .
w; (Z(�'11 F t Lai .,-.�• SUM -NIP,
. ' !s}-1,74 :511►PATIO COVER
10600 1
'l♦; a/�_ � :,,.i �' i.
Q. Q. Q.
v v v
RAFTER SPAN TABLE ; 4 �` � 'oo
GRADING RULES 3-7 4 y �� o� ALL CONSTRUCTION SHALL CONFORM
PS 20-70 �' �' �`� TO THE PROVISIONS .OF. THE 1994
(FEET &. INCHES) oOJ4� �J�� ooJ�� - UNIFORM .BUILDING CODE. r
2 2 2 20Q SUPPLEMENTAL NOTES:
2x4
16'
O.C.
10'-6' '-Ir
1 7' -8'
-gr
2x6
'16'
3T
O.C.
15'-T '-
,- ;-
SIZE .SPAN
'
. 4x4.:...4'-
4x6
2x8
16'
O.C.
4x8
400
At
400w 10,
..... ..._w..rr.wr.ww-r...._rr_w.ww rw....r.r.w...r ..r.l...
................. rw r_..r... r .. _....r ........ .....................................
.rr.
NOTE:
& O.C. SPANS ARE ALLOWABLE FOR. OPEN LATTICE ,
PATIO COVERS ONLY.
LATTICE
ROOF
BUILT-UP ROOF
HEADERS.
HEADERS
DOUGLAS
FIR NO.,.l
DOUGLAS FIR - NO. 1
SIZE
SPAN
SIZE .SPAN
,4x4 ........................ '.-Q"..r
. 4x4.:...4'-
4x6
'
4x6 '
48 ' ...... w _....11 '-
r14'-
4x8
400
400w 10,
4x 12
402'. 12'-
6x8
14'-
6x8 1 '-
6x 10
,17' -. M
6x 10 .r _ f -, ._..