704-008 (PAT)N �
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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
Ilhereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Orp ol, 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&RC. 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 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
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 proppert/y ffor icti
nspeon puurrposes.
Signature (Owne%Ag t)'0. r,17 �) 141- 1- Date
BUILDING PERM 11 PERMITA17t `oms
412/97 .19�'ryC.M.lif�
CONTROL#
4 915
DATE VALUATION LOT TRACT
JOB SITE 46-401v"v" "tjt I,t.,xa.41-1A� UAN e
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.E()11fJ �� i 8 L1iI�1
OWNER FUJI! LDRR
44-340 B(J"D'iEdtGUI1 LANE
E'_.A QUiTJ'1'A 92253
USE OF PERMIT
PA 1:10
f?WRt,.YUPATIO i)F
C+•&I'MATI?.1)WSIT of C ONST.OeiJG"x"t(. N
4,7.56,00
K, Ali t.t14.rCX, 0i,,t 101-000-439-318
f7X)N8TR.(iC F!0NFi9? 1014-M-418-000 ST2,00
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SUB -TOT ALCONST.RUKT, IONAND T,A'PlCHECK.
S118,89
HESS RPM. -PINI D FUSS
Won
TMAT,) ERNO.T W4..)1. ENO W
$118.8111
RECEIPT
DATE
BYf/
DATE FINALED
�i.
INSPECTOR
•..._'5x9 n
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 Pibg. Test
Final I
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:
-- ..._s - ee�
twelov mk%dh� . - - - —
rte:
COPEN LATTICE PATIO COVERS MAY BE ATTACHED TO OOSTING FASCIA U -STRAP OR AN
. VIA ONE 1/<' x S LAC SCREW THROUGH FASCIA Miro EACH RAFTER TAIL
NOM-00lMlOSIV[
3/HT x T LAG SCREWS INTO STUDS AT 1Ir O.C.
CONTINUOUS LEDGER
0;1 C ti •+� •� er OIf OOLTd No"
LIJLl:6����
BUILDING DEPARTMENT USE ONLY
PERMHT MAW
PERMR ISSUE DATE
FINAL INSPECTION DATE
SPECIAL CONDmoNS
wIOMOE 1' CLEiiRANCE
eETVM Past AMD
,} 0.4 yy Pos
OR BOLT IrAll!
/F'ct�Ht R
Y
ocIwcEN PM
TYPICAL PATIO COVER
M%n OF APPUd►Tm
owod" NAVE
rnw ADOILESS
Cm. ST Zr
TELEPIHOME
H.O.A. APPROVAL 310 MTLMHE, DATE
mo ■
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RAFTER SPAN TABLE �� ��
GRADING RULES O
PS 20-70 1*
(FEET & INCHES) OOJ��'' ooJ��i OOJy"
ti
2x4
15' O.C.
24�
10'-6r '-I'
7' -sp a.-
DOUGLAS FIR NO. 1
DOUGLAS ' FIR NO. 1
2x6
16r O.C.
15'-(f 4'-
'-!r 13'-
N
1'—
pxl4x6
4x8 81— __
2x8
1 I O.C.
24' ''-
37' 0
1> '-Q".. 17'-Q'.
4x12. '—
6x8 14
6x8 12
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 ....................... '-Q"„
4x4 . -,—
'—
1'—
pxl4x6
4x8 81— __
4x10'—
4x12 7'—
4x12. '—
6x8 14
6x8 12
6x10 .....................17',-,
6x10. 14 -ST
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.