9706-109 (PAT)LICENSED CONTRACTOR DECLARATION
- 14ereby affirm under penalty of perjury that I am licensed under provisions of
Chapte�.9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Licen$e # 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 j-aw for the following reason:
()() tl ,as owner of the property, or my employees with wages as their sole
c'oTnpensation, 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
( ) I am exempt under Section , B&P.C. for this reason
Date /A .-f -.ai Signature of Owner r�'".� .. , r•
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 gue and will maintain workers' compensation insurance, as required by
Se�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
j Code, I shall forthwith comply with those provisions.#`
Date: /V -
/2nApplicant
Warning: Failure to secure Workers' Compensation coverage 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.i
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
fie above-mentioned property for inspection purposes.
Signature (Owner/Agent) e.." r _ -_ Date _
BUILDING PERMIT PERMIT# CONTROL# ..
9706-1095372
DATE 6_1v 97 VALUATION1'0,.4+go LOT TRACT
JOB SITE'
ADDRESS 45.110 BR1i)cF.rrEw,%y
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
VIRG€P3€A KOSEY
OWNS}:! BUILDER
45€10 IHUDL,91 11 Wil
€ A QUIN'€'A CA 02)53
�
USE OF PERMIT
PA't'1t-t
T*ro t0l. +401N 1,Ail WE PA"i'10 COVER-
. I.+4,t€ii,'€t�1rA7'ii_i "it+.Ob �iE
ifMINIA"i'ED COST i3t+ CONSTRUCTION
10,054.80
t',+:ii�llt>•, i �'i:E;11i}13EVi11Kti
11.I.AAi +''kitie'K Irt4i 101.0 A-439.318 S91.!411
a"(1N'41i1ir"1'K►N Irirtr f()t.-{}fi(! 41R,()f)(jflZ Ito
RI:%D 101.OM-:41-0 $101
'
phlR
;:t 11I-'t'r71'A1,['t)NS1'ftlX711ON AN1) 01,AN C'111-*C;h
570991
JUN 16 1997 €.€ SS P12ETAID FE S
S0,0 ►
��,���-�� 10 i'A, , tij�� RM t'f i� VY3 011f, NOW
$2t1K 91
�! LN
�I
i ! i ;
RECEIPT
DATE y�
BY
DATE FINALED
INSPECTOR
r
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
POOLS - SPAS
BLOCKWALL APPROVALS
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 a
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final.
Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
I) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r` (y LO
1 W �P
CS Z r— Date Signature of Contractor
CDO1�_
J (-) C:) OWNER -BUILDER DECLARATION
WLULU r- 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).
C'') () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
Cn
d Q WORKER'S COMPENSATION DECLARATION
o 11 1 hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q U ( ) 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
d 0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cb5)
r-0
J (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.
Date: 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.
Signature (Owner/Agent) Date
BUILDINGPERMIT PERMIT 9# 0w) CONTROL#
4"1f 6024
DATE 6114/97 VALUATION •; " ¢� LOT TRACT
JOB SITE 45-t2O WKII)GE3"Utt; WAX
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'l IRG'NTA K()Mt
45120I3.RIDGETT8 WiVi'
Lei f_}flhrl't! CA 92253
rr3�.te
USE OF PERMIT
/:70 :id. IJPI;N 1.A.i I PL L.VKJ t0 t QV LIC
t
COST O �".�::a�1:��`stala:�'���
J0+0.%.11:)
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Pl. AltitCIVCK FIEF.
C`i'�i�tpp:"r`Refr,Wt'li1'Y�t��t; 1.1�►
N7�ii/P1+•dii.�fi� -!(!1K1'}ef!11
p �! Tt-'V111, 4N1I�0!))-w-fy
USS }PRU,-3"r``r,.lt) ETES
9SD.ii�i
'3'04'siL P}+X(12IT t+ CCS CAPE N0W
S24M.91
RECEIPT
DATE
BY , ,: i< <
DATE FI ALE
INSPECTOR
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steer,
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:
1 �
A Ali
Automobile Club of Southern California
-
4 6- 0 5 0 W A S H I N G T O N S T. • L A 0 U I N T A-. C A L I F O R N I A 9 2 2 5 3- 2 0 9 8
MAILING ADDRESS: P.O. 8 0 X 1658 LA QUINTA, CALIFORNIA 92253-1658
LA OUINTA DISTRICT OFFICE
(619)771-1162
(619) 771-0045 (FAX)
VIRGINA KOSEY
45120 BRIDGETTE WAY
LA QUINTA, CA 92253
PH 3284600
CITY OF LA QUINTA
ATTN-: GREG BUTLER
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
DEAR MR. GREG BUTLER,
AS A HOMEOWNER POLICY HOLDER OF AUTOMOBILE CLUB OF SOUTHERN
CALIFORNIA, VIRGINA KOSEY, IS COVERED FOR WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY FOR ANY PERSONS SHE HAS CONTRACTED WITH FOR EMPLOYMENT
ON OR ABOUT HER PROPERTY.
PLEASE FIND ENCLOSED A DELUXE HOMEOWNERS POLICY WHICH
DESCIBES THE COVERAGES IN QUESTION. FOR ANY FURTHER QUESTIONS PLEASE
CONTACT OUR OFFICE AT 777-4790.
SINCERELY,
CINDY J.HNSON
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) 777-7011 _
O 'S SIGNATURE/DAT
S—f .21-i
PROPERTY ADDRESS .v
4F 2_7
PERMIT NUMBER(s)
y
I /
RAFTER SIZE AND SPACING
ROOFS fPI CH
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZE —
_ &---
�1 ( h
RAFTER SPAN: __� , 2
DAi i i cn,rTu• � 25 A
w
h Z
J
O.H. w
a
0
a
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING NOTE ON REVERSE)
QLc
O.H.
'T'AND 'L' STRAPS
6"x6"x1"xl/8" WITH
(4) 16d NAILS .OR BOLT
POST SPACING: b
OVERALL LENGTH: --
jQ __pW - --41IU I POST SIZE: __ L_X- _
REAR SETBACK SIDE SETBACK (4"x4" MIN.)
r
.
FINISH GRADE FINISH GRADE MIN12" x 12" FOOTING
2000 P.5.1 CONCRETE �i I I I 1.— I I
L_ J L_ J 12" BELOW GRADE L_ J
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
NOTE:
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4" x 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
3/8" x 5- LAG SCREWS INTO STUDS AT 16" O.C.
CONTINUOUS LEDGER
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
U -STRAP OR AN(
NON—CORROSIVE
(4)- 16d NAILS
OR BOLT
U—STRAP OR ANGLE
(4)— 16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT APPROVAL BELOW I SII
CITYOF LA QUIN T A, ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
E3UIL0ld C ( SAFETY DEPARTMENT
n "f ,0ND NIALLY TYPICAL PATIO COVER
ACCE� ` �^-), FOR CONSTRUCTON DATE OF APPLICATION
SDS -,E -C T TO INSTALLATION AS PER
OWNER'S NAME
CODES
STREET ADDRESS
iD ALL APPI- ABLE CODES CITY. ST ZIP
_ /71 . . / �_L . „ OO TELEPHONE
DATE
BY
H.O.A. APPROVAL
z
RAFTER SPAN TABLE �` %� �` �� �` Ate. pp
GRADING RULES `� S Co S C O�
PS 20-70
(FEET & INCHES)
�O ""VV >O n j �O 'IV
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
• o.c.
SIZE
SPAN
4x4
5'-0"
4x4
4'-0"
14
4x6
.
4x8
®i
4x8
8'-0"
x
1 -
4x10
10'-0"
4x12
17'-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"
14
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
x
1 -
4x10
10'-0"
4x12
17'-0"
4x12
12'-0"
6x8
14'-0"
6x8
12'-0"
6x10
17'-0"
600
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.
Zq K �- 1 /72-
iii
. ol/xts?-X/z
-,97