9706-085 (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
445758 C: -R 91W9_7
D' to 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 owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(.f)/I am exempt under Section B&P.C. or reason
Date / "2 Signature of Owner
WORKER'S COMPENS4TION-DECLARATI
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
perfo,rfnance of the work for which this permit is issued.
)OVI 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.
r
(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' compensation9visions of Sectio, 700 of the Labor
C,ade, I shall forthwith comply with those provisions. t*
te: > Applicant" r
Warning: Failure to secure"Workers' Compensation c�od� erage is unlawful and
shall subject an employer to criminal penalties and civi 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.
n
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 Cityd State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the -above-mentioned property fo r!Kection purrppo P<_2 . �/
/Signature (Owner/Agent)'' .r/ Date�a
,BUILDING PERMIT PERMIT# C°NTR°`#
A706-085 Si 3 4 2
DATE011,/97VALUATION _00 LOT; TRACT
JOB SITE
ADDRESS 41.5-095 RAMALEAMIOD CT
APN %
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LAl,!RENCti i_). CRAIG ,1E .
!?ti'L�rEi'k,rt31,11.3��sf:.
4-1:09510—NIBLEMCM Cl-
1.A QUIWA CA.
C91,# 1295
USE OF PERMIT
1�.ArI"tS.i r
i,ATT103 PAT10 COVER. 10 X 45`
U.Et 1b'Mr1O 4500
Jj
l it "8MATED CY , 0V C'(9lttS"3'U.1 Cf ION
E
PLAN rtIG;C'h FEE 101-000-439-.318 152,65
C0K';'f,12tu,'710N FRE, 101-000-41940) 0) $k31101D
S'fONK3IN1CYI71014AM- - kESIK) 11.01 -00(} -'124I -M S.fid)
V
:^9
5t. —T(7'1'r1i,t;'s:1iV`ERtr�i"1tpN A.Nl�1'E,.�2�i<".iiN:C1�
S1:Z4.215
LESS. PRE-PA.ID
$000
TMA U t'N:91:MIT E+'!JUS E?VIC'NOm1lr
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
r -
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 Wail 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
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 Vottage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a.
Q QQ
°
RAFTER SPAN TABLEA�- A O
GRADING RULES'`'' C 67 C7 C7 &L CONSTRUCTION SHALL CONFORM
PS. .20-70 � ..=�sW �S� �`�° TO THE PROVISIONS OF THE 1994
(FEET & `INCHES) �J~� J`� pJ�� �. ? UNIFORM„BUILDING CODE.
O
ry p
SUPPLEMENTAL NOTES:
2x4
16”
O.C.
10'=6' '-6'
7'- '-
DOUGLAS
FIR NO. 1
2x6
.167
O.C.
015:- 4:-
�-
U-gr24"t
4x4 4'-(_
4x6 '-
48
11'-
48 __. �8_-
.4x10
] '-
400 '-
4x1217'--!d*,402.
2x8
16"
O.C.
14'-
'-
6x8 12' -
24'�-
6z 10......._._.14w- «
.NOTE. ",---A y - - - - - — -
3r O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY. ULDING & SAFETY DEPARTMEN
T
CONDITIONALLY
LATTICE
ROOF'
BUILT-UP ROOF
HEADERS
HEADERS
DOUGLAS
FIR NO. 1
DOUGLAS- FIR NO. 1
SIZE
SPAN
SIZE SPAN :.
4x4' -Q",;
4x6 '-
4x4 4'-(_
4x6 '-
48
11'-
48 __. �8_-
.4x10
] '-
400 '-
4x1217'--!d*,402.
'-
6x8
14'-
'-
6x8 12' -
6x 10 .....................17'-
60
6z 10......._._.14w- «
ACCEPTED FOR CONSTRUCTION
SUSPECT TO INSTALLATION AS PER
ROOFING l g=;[ PPLICABLE Co
A. /U/� P, RID®�YROOF: S. TO DRAIN.
9
SPECIFY AND 4CATMOOR 4 LATnCt
RAFTERSgIE AANNO. SPACING
�FING NOTE ONG REVERSE)
ROOF
L�T
-470
CONTINUOUS LEDGOt
N /
T AND V STP APS I
E•xb'xt'x1//d-WITH
(4) IN NABS OR BOLT �
RAFTER ON,
POST SPAcm.
O.M.
O.N.
/ OVERALL LENGTN:
�p OvatALL LDGTM,
m
WN. Sx<' POSTS
' REAR SETBACK
SIDE SEIMiCK
2000 P.S.1 CONCRETE �� FlION.
Irxtr FOOTWO
I r BELOW GRADE
PROM 11-cLEiiRANCE
KYWMPOST NO
bow:
CONCRETE
PATIO OOVM MAY K ATT_ _
OPETO CaSTING
VIA ONE 11C x r LAG SCREwV TrOMM FASCIA WTO EACH FRW= TML
U-STRA► OR MOLE
NON-CON1103 E PLATE �pE
P'
3/S x S LAG SCREWS INTO STUDS AT I d'NTO.C.
CONTINUOUS Uwe
NA"
( } LS
w
OR SOLM
U-STRA► OR A4=
._.
•
/DLT 1M WAS
JOIST FI*4= OR SOLD BLACKMO .
MAIL RAFTER TO U.00KMO
ANCHOR
0mK M (OONCIIETii
TO M POST AND
CONCRETE
BUILDING DEPARTMENT USE ONLY'
TYPICAL PATIO COVER
PERYR NIJLIBER
DATE OF APPLICATION
PMIT ISSUE DATE
OWNEWS It"
FINAL INSPECTION DATE
STRE$T ADDRESS
sKc ft coNDITI0w
ON. ST 2t
TEL81"NOW
N.OA. 0MV& SIO#M=M DATE
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.
Contraciors 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 of 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 aie 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. ,
Formorespecific 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
78-105 Calle Estado
La Quinta,. CA 92253
(619) 5 46
' F 9) 564-5617
WNER' S, SIGNATURE / D
PROPERTY ADDRESS
- �- 9�aG -ate • . .
PERMIT NUMBER(s)