9908-040 (PAT)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
[ .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 owner of the property, .am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
.( Tam exempt under Section B&P.C. for this reason
Date Signature of Owner i\A I1. I ,d^K4
WORKER'S COMPENSATION Q, RATION �
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. Myworkers' compensation insurance carver & ,policy no. are:
Carrier PolicyNo.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ,}.I•eirtify 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 tothe
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 fo hwith comply with ,tho� ,pr visions: • . •`
Date `
Warning: Failure to secureCrminiBlIpenaltles
rkers' ompensation covera is unlawful and
shall subject an employer to and civil fines to $100,000, in
addition to the cost of compensation, damages as provided'for'in Section 3706
of the Labor Code, interest and attomey's fees.
IMPORTANT Application is hereby made.to'the Director of Building and Safety
for a permit subject to the conditions. and .restrictions set forth on his
application.
1. Each person uponwhose behalf this application is made & each person at
whose request and'for whose benefit.work is performed under or'pursuant ,to
any permit issued as a. result of this applicaton agrees to, &• shall, indemnify
& hold harmless the City of La Quinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes. null and void if
work is not commenced within 180 days .from date of issuance. of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property r I pection purposes.
Siertatiire (Owner/Agent)' ID
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BUILDING PERMIT -PERMIT
'
91%M -"i
DATE f�6ppVALUATION �C.ii1 LOT TRACT
JOB SITE ADDRESS .15-38S C A-ItRI .:LAKE.
APN . _
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i l•.l()1iV tom,,. 1!i:.l\F.i•Vi•.i I'♦
i \%k fhiL P 411 `IF ("�.:.9�!.
E:>� -� 1./�$i tRIE
I.A. C?CANT/V CA. 92253
( ) C;RT,#
USE OF PERMIT
R' Li1r* i _Wt, CIATit'-, CO E1l - - -
k'+i'�t�il'"N.�r.4ti ,t'%nl,9�1 .sl°•
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,. - .... � �` J�&.SONO'
fICAMIT FEE SUMMARY
PLAN t fU7`.CK f'IF.:.F I()I-t.�t1t?-`I.1�.. i,[4 �.5.~•.6r1
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t_s�r��s-r�far>;.,,prr�rr•�t�I�I? iR)�#kut.-•�PS••t�fa) Rf�t,Bt)
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,t.RI-1terY)CL(_.10tit,1"KIJC::t'it;1N1 AND .Pi,A;J("1,(1";x"i:
$111110
j..f��:� (yf�:E:-�•'r1Xi'l��f'S
9Yt.t'r
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RECEIPT
2 .
DATEBY
I
:....
DATE FINALED
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALLL APPROVALS
POOLS a 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:
RAFTER SIZE .AND SPACING It
It
I / ROOF PITCH
CONTINUOUS LEDGE
(SAME SIZE. AS RAFTERS)
HEAPER SIZE —
RAFTER :SPAN:
4�
2000 P.S.1 CONCRETE 1.
L_J
SPECIFI ROOFING AND SHEATHING OR OPEN LA-r'.:E— T
(SEE ROOFING NOTE. ON REVERSE)
ofs4,4 l�R-►TtL�-
--------- ,
r L
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.
BUILDING DEPARTMWE.W?JW#LFFpE O
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT, ON
THE SITE FOR. A SCHEDULER
INSPECTION.
Jw MPTIONS1
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 8Y
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
ANCHOR BOLT (EMBED —
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME Dott'j C_f1N�
STREET ADDRESS 45
3
Cft(44 f- LA+jf-
CITY. ST IIP L vLff( f�
TELEPHONE
H:O.A. APPROVAL
ti1A
4Z.
AI lZl
RAFTER SPAN TABLE 4"
`�7 `Z /
C.) ALL CONSTRUCTION SHALL CONFORM
c7
GRADING RULES
TO 'THE PROVISIONS OF THE 1994
PS 20-70
UNIFORM BUILDING CODE.
(FE & INCHES) oz-> Z5
/0'q,
2�� �Gi~ ��� �CQ / SUPPLEMENTAL NOTES:
2x4
16" O.C.
24"
10'-6" 1
9'-6"
7'-3"
8'-.9"
'8'-6" 8* -0" 6' -Cr,'
1 7'-3"
DOUGLAS FIR
NO. 1
x6
2x6
16" O.C.
24" .
32" "
15'-0"14'-0"
SPAN
10'-9"
13--0"
12'-6" 11'-6" 8'-9"
10'-6"
10'-0" 8* -6' N/A
N/A I
4x6
6'-0
M
16' O.C.
24"
32"
18'-0"
17* - 0"
13'-6"
16'-0"
15'-6" 14'-6" 11'-0"
11-0"
11'-6" N/A
N/A
4x12
NOTE.
71V O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY.
LA7110E
ROOF
BUILT-UP
ROOF
HEADERS
HEADERS
='I=
r\lo. 1
DOUGLAS FIR
NO. 1
SPAN
S I Z. E,
SPAN
5'-0"
4x4
4'-0"
I -rx6
8'-0"
4x6
6'-0
j/4x8
1111-0"
4x8
81-0
4x10.
14',-0"
400
101-0"
I 4x12
17'-0'
4x12
6X8
14'-0"
6x8
12'-0"
6x'10
17,-0"
6,x 10
14'-0"
fts—,-
ROOFING NOTES:,
A. BUILT-UP, ROLLED ROOF: SLOPE, TO DRAIN..
B. ROCK ROOF: 3/112 MAXIMUM PITCH.
4
441
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 propertyowners 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 State
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 -1760)-777-701 L
1C)'WNR'S"SIGNhTURE/DATE U
45 38 S CAC,&t AS
PROPERTY ADDRESS
ft9-r4()
PERMIT NUMBER(s)