9712-044 (BLCK)LICENSED CONTRACTOR DECLARATION
`. I hereby affirm under penalty of perjury that I am licensed under provisions of
H i Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W f Professionals Code, and my License is in full force and effect.
ch License # . Lic. Class Exp., Date
Ln'.
U.I
oZ r— Date Signature of Contractor
to O�
U OWNER -BUILDER DECLARATION
Wa I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).- r
�
( ),.,I am exempt under Section B&P.C./for�tfis reason
O N VDate rl y ' G , G 7 Signature of Owner
U 101- Q WORKER'S COMPENSATION DECLARATION
p Ir
2I hereby affirm under penalty of perjury onerof the following declarations:
Lo H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q (� ( ) I have and will maintain workers' compensation insurance, as required by
O C) Q Section 3700 of the Labor Code, for the performance of the work for which this
a LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
oo 5
0 r
J (This s 'tion need not be completed if the permit valuation is for $100.00 or less).
( t)"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
3 Code, I shall forthwith comply with thoseprovisions.-•"•`v
VDate: '§ ` U —,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 representative"Of this City to enter upon
the above-mentioned property X in�spec�tion purposes.
Signature (Owner/Agent) f - ����"'Date
' BUILDING PERMIT
PERM'f# . -�_ .�, CONTROL#
DATE 1,219197 VALUATION S1,77,S 0+) LOT
TRACT A 7
VVVV. 111
JOB SITE n► �q �Y r
ADDRESS !}5"�+'�4,1'..��O0 *�.tr�.��i..C�.RE S11 DRIVE'
OWN�JER�
CONTRA(C/T�O�R7/tDESIGNER /ENGINEER
�[t�y�r
+5y�8ll��d�{y-,+Ery_Yr3�i•7Y.f�1t5�.`V�t�Yy�ySl�o`i
it
LA E?i iNrf'A CA 9225;
C" lup
f
USE OF PERMIT
�i.fli�i3j�i>.�
•
DEC 0 91997
Cf'iY O � NTA
6 rr. WALL
71- ,k
{
;b
MIFILIVIATI.E.Dt 'h"1031' 01? CON'S"IRRUM11UN
�; �+?��: f'i�� ts� 3YC>t�i t� �i� � l.7I ��-,q { ii•tH1f3 �•f; :t..€Nt �-
�f,fi�t.Tt"1�#���)'.. �`c-3�v�r'�f 1f;;t�1f�R1 ��Nf;ti s�t.a�rJ �:ja.l.?r•77�
t L $0.11
(v
'.1'OT!A1, P14,kj4 IT
fet,F-S 0 t E, t'k!)W
RECEIPT
DAT � �� «�� ��
BY-" `� p
DATE FI ALE �
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
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 APPROVAL
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
Fcdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.'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 AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760)(7,77 701
OWNER'S f IIGNATURE /DATE
PROPERTY ADDRESS
q -)la - 61
PERMIT NUMBER(s)
SPECIES 4 GRADE
MAX. 0/A SPANS
WEB BRACING RLOUIREHENTS
NOIL+ 1X1 CONIIN1111115 LNILWIL ORHCINI: hl(11Cr1-
2X4 T/C 2X4
B/C
NCD HER RED MAXIIIHM SPINI Nn DNF
EO III TIIE MIUPnINi OF NCO H{lll 1N BO
_----------
. 'SIZE DI(AUC OF .HUBS WITH: BknCC ORIICE
NIIILS HHERL• INUICHILD UY I.).
--------------------------
2 2x 1 .3/Si
.3/STUD S -P -F 27' 1. 32' 0'
NOTE+ LOCATE INTER -PANEL' SPLICES
D O U G L A S F I
R- L R R C H
AT 1/4 PANEL LENGTH ./- 12'.
-------------------------------------
TOP CHORD SPLICES:
NOTEt PROVISION MUST BE MADE 1N THE DESIGN
D•5•STR• MC -15
31'- 3' 32 -
D"
IS�1
(IF TIIE HnLLS (BY 0111FRSI In ACCIIIIHO-
0.5 -SIR •
30'- 7' 32'-
0'
2445 TO 32'- 0-
OAIE LAILRHL DISPLACEMENT [HORIZONTAL
THRUST[.
SEL •STR• HC -15
30'- I' 32'-
0'
•l DENSE HC -15
30'- 6' 32'-
0"
SEL•STR•
29'- 4' 32'-
0"
at DENSE
■1 MC -15
■2 DENSE HC -15
29'- B' 32'-
29•- 2" 32'-
28'- 7" 32'-
0'
0"
0'
Tpollssro,E(
}o�s«".`�at/� man µ0A/ try
?� r IIT �`4. /%rf� C4
■ 1
•2 DENSE
28'- 5' 32 -
27'- 8' 32 '-
0"
0 '
IY/iY i 1� °i 27/x'
a> CIVIL�. a a
sYnn •
ABOUT
■2 HC -'t5
27'- 4' 32'-
0'
'?+�„„y�A
R2
26'- 1' 32'-
0"
^o. 6310 �'ft Of C;LjW) \'
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
H E H - F [ R
- - - -
TPo((ssf0,4 L••
o •.........•r
.. � •(.`- __•'
��. •.t PIJIC�
3215 10 25'- 6'
n•
1015 TO 3. - O '
SEL SIR•
27'- 0' 32 -
0"
Ho al�l,y/�� )'/� ?TINT °'
- IIM lM e �
`•./�Z`%1J�,c
/LATE ROTATED 90 DEO.
N I
25' - 8' 31 ' -
S'
/ (J'I.:�"T:�
'
.
...... .....•
J'4/(0(OTI�
------------------------------------
S P R U C E- P I N E- F I R
------------------------------------
-
f �•.'n:.�v��
a:�ngq �Ls;lne"` frc
�a'luai a vLwigP/o F���
'/
CE
1860610[32'- 0' IS-)
NO CE
2116 ToO .
3 322'- o•
SEL •STR •
26'- 0" 32'-
0•
J
■I
24'-2' 28'-
5'
il QIY
■214
_ _
IF,9,1 4,,
<
_______
--2----4--------7--
iJ'4,, or 100 12
111.'
yr41D()S4(
M 5 R (FOR SPECIES
LISTED ABOVE ONLYI
4C�:--
240OF-2 OE
32'- 0" 32'-
0'
225OF-1 •9E
31'- 4" 32'-
0"
4375 to 211'-10•
2)OOF-t •BE
30'- 6' 32'-
0"
4890 10 3_'- 0"
1950F-I.7E
29'- 9" 32'-
0"
I800F-1-GE
28'-l0' 32'-
0'
165OF-I-SE
28'- 0' 32'-
0"
0830
I50OF-1.4E
Ia50F-i
27'- 0' 32'-
26'- 3' 31'-
0'
1'
" 2
SIZE HF.'Sf`F 12
O
-29 — ci+�tc�
•3E
24Vn 23•- F-
a,vo�c,<1
------- _________________________
3275
S��q/)
N E B n E H B E R
S (EOUAL OR BETTER)
3290 511- 0'
40.15 32'- O"
-------------------------------------
nr-L
2x4: 83/STUD S -P -F
'4'/'. ^li'• H•
2490 31'- U•
C'�/�
2,,,J'O -
csk/,S7 -6 6••b4SdF
3275 32'- D'
v
OVERALL SPAN
11 1� IH( /EnIVII;IUILIII of
DIMERS 10 ASCERIO:N
THAI tHE
LOBUS UTILIZED Crl IMS LIESICN nEEI OR EXCEED (HE
MAX• SPAN
CODE
SPACING
DATE
ICI.1AL 01 ND LOADS IMPOSED BI
ICAL CLIMATIC RECOROa. 110 RESPOr15l0ILITT
THE STRUCTURE AND THELIVE
19 ASSUMED
LOACS IMPOSED Of THE LOCAL BUILDING CODE OR HISTOR-
FOR OInEN9[OIIRL ACCURRCf. 11ERIFT P.LL DIMENSIONS PRIOR
'IIURLITT
LIVE LORD....
16 -0
32'-0•
UBC
24" O.C.
8/22/89
(D FABP.ICRIIDII. FABRICATION
I IPI[ RrID INC tR115NRL TRUSCOn
SHALL CPLT NITX IME
DO CONTPOL MRIIUAL' OF INE 'TRUSS PLATE [NSI ITUTE
MANUAL• CONNECTOR PLATES SHOIIH ARE TRUSNAL 16. 16. OR 20 OADE AS SPECIFIED.
OERO 10A0..:...7.
--
•(]..s.r.
T R
'
I'L11i ES SHALL BE APPLIED 10 BOTH FACES OF THE TRUSS AT EACH JOINT. ALL TRUSS JOINTS SHALL BE TICMT FITTING
U S NRL
•1110 R01 PLATES RNRLL BE TIO11 IMOEOOEO. PERSONS ERECIINO TRUSSES ARE CAUTIONED LI SEEM PROFE3SIONAL AREFER
wfLARDI NC IEMPORNRI ERECTION BRUCIND Mnl[H 19 Rl.lAiS REOUIRiO TO PREVENT TOPPLING AND '0(RIINOIND". REFER
ID 'UkHCINO IRUSSE S: COMMENTARY AHD RE COMnEHONf IONS* [TPI). ONLY IDT ERR[ tlR9CIN0 REOUI RED Of fN0[P(DUAI
CEILING 0•L••.,•
TOTAL
O •Q
33.0
SYSTEMS
A T R U S W A L S T A N D A R D
In1UD
IRUSS nEMeERS IS NOTED ON IIIIS CRIININD. INE TOP CHORD
19 ASSUMED
TO BE LATCR:LLT BRACED AT SHEATNINO UNLESS
■
....r.
I(HIANISE TDfE9• IMF' BOTTOM
CNfIRO 1! A9 S11MEn f0
BF. LA'ER(ILI.T
OWED IF Rim CEIIIND moirkinl 13 At IACHEO
■ 6 P3/ CLILINO
8925 STERLING IAO ST•
sc-32-4-12-33X
�,• 4 �} u'
'll Y.l Atr IU [III IIIITIIN IHillRD. DIIICNNI'1. 1NI'llk" UNIIf.E Ihl: Nntwii FIumn 111 INtrPY(RH NIIl I-XCIIIIINII IH• -0-.
rNNS`19 Ll It ulll U[ 1'l HCl 11 IN INI1 filYlNuriniNl Inst Nlll CIIU:fI MIL nUISIIINC CONIINI IM IOL HUUU IU CXCEEU 19X
REO(1CTION TAKEN
mU/UN CAU 5E CIIBIIECIUI' PIATE
CUNROSIIRI. EIIMUER. NIIICH
IS
IIOf H 9TkUCTURHI REOUIREnENT OF IME IRU55. MITT HE
254 DURATION FACTOR
SUITE 150
.
ITIIIFED f0 MAINTRIII UN1FORn
CEILING HEIGHT Ano PROPER
APPEARANCE. WHEN DESIRED. CnnBEk IS BEST DETERMINED
IRVING. TX 75063
'
.If .mpirinus n('PIIOIIIOn of
FTPFRIENCE .Alin THEREFORE IS
OUTSIOE TIIE SCOPE OF RISPONSIRILIT/ OF TRU7HAL.