9609-114 (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
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).
( ) I am exempt under Section B&P.C. 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, • cir'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 ai
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.*l agree to comply with ali'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 + 1 f
PERMIT# CONTROL#.
BUILDING PERMIT 96094-14` 4053
DATE 911"6 VALUATION '. $6,3P 4.00 LOT TRACT
jOB SITE 45-055 I0'ia.l�.PH.'�sI�VIV'OOD CTAPN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
OYD� RANDY .&CA1•HERTNE Ar!
45-055 PLAIv18.i.EWOOD CT
IA QWNTA CA. 92.253
r'cl<_�f772•-I t 7i
r�l..d;
USE OF PERMIT
480 5.P' C0VL?RJfft PNY10
t+.;.%`D"lN'IA°I'EV COST 01+' Ca3pr`STRUMON
6,3 ;:19
;l"k;44-X91'1' �� r�� btlti4lt�A��`
P1 —AN t14EM FE 1 C? i "fivV 431'-3 P tt S_". s0
CY, NS'i'T21;i✓"C`90N FEL. lUl Ut)Q-ft18-QtDU QnU.aU .
j%liv i C),rW%14 W&,, - "SIO 101 -000 -241 -ON �.
CO �i
CT)
L a)
LL.
Q( LLB
1kt
s
AND P1 AN CHECK
LIFSS Ph'.&NAID FEES
S0.00
TOYAL PERMIT FENS 9)U>F NOW
$149.14.:.
RECEIPT
DATE
BY
DATE.FINALED
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 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:
.A
RAFTER SIZE AND SPACING
_q.X61 - -Nr
SPECIFY ROOFING AND SMEATMNG OR OPEN LATTICE
(SEE ROOFING NOTE ON REVERSE) 7
--------------
- - -----------
ROOF PITCH
. .. .:. .
CONTINUOUS LEDGERWA
NEADEit' SIZE,X
T AND 'L' STRAPS
I orwil'x1/S NIITM I
I
(4) da NAILS OR 901T
RAFTER SPAN' T
�� POST _ SPACINGFr
O.N.
•O:N.
�'Z' d' •
OVERALL LENGTH.;,
r OVERALL LE am-
MIN. irxS POSTS
' REAR SETBACK
SIDE . SETBAC.K
' FINISH GRADE
2000 P.S.1; CONCRETE�
-IL�
FlNINN , GRAdE- ti
•: M.�_
I
J j Ow GRADE -
PROVIDE I' CLEARANCE
BETWEEN - POST ANO
COMCRM
OPEN LATTICE PATIO,COVERS !MAY K. ATTACHM TO EXISTING FASCIA '
VIA ONE 114- x S' LAG SCREW TFIROUGN FASCA INTO EACH RAFTER • TAIL.
U -gam OR ANGLE
5
"NON-COItlIOSIVE PLATE �E
3/I!1' x S LAG SCREWS INTO STUDS AT 1 S' O.C.
CONTINUOUS LEDGER
N NAILS
w
ORI
ORBLT
7 1.- �711
U -STRAP OR Air M
`�� •�\
(4 Lee WMAS .
Ort eo�t
L.
JOIST KHMER OR SOLID BLOCKING
j
NAIL RAFTER TO BLOCKING
-
.-CITY OF
! LA-
PRO .ID£ I' CLEARANCE
Rr I I O1
r. 800M POST AND
& SAFETY
CONCRETE
- PARS ENT
BUILDING DEPA ' ENT_'USE PATI 1 COVER
.ONLY,, :.�,
.,,......TYPICAL
PERMIT NUNBOt
T" V
e, o pr
PERMIT ISSUE DATE
OwNER'S NAW •
FINAL INSPECTION DATE
AND ALL 7�P
L
SPECIAL CONDITIONS
CITY,. ST. zp y
DATE
N.OA. APPROVAL SIGNAMRE. DATE
• Q. Q. X��c v
RAFTER SPAN TABLE
GRADING RULES
PS 20-70
(FEET & INCHES) OpJ��i OpJ��i OpJ�i� G�Q3
2x4
16"
24"
O.C.
10'-6" 9'-6" 7'— 8'-9"
'
9..- ...-.. 6.-... 7...-...
2x6
16"
»
32''.-....
O.C.
.
1 '—
14'—
1'—
'— '—
$�-.A .�Q.'.-.A.
.........................'... -Q".._
2x8
16"
3L
O.C.
"
1a�.-(r 17'—(r 1.X'- ...1.�'-q'..
.�.tl.. .... A �.�...........N A........1VA.
NOTE:
V 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...._...._.._
46
'— `
46
4x8
11'—
48
4x 10
"14'
_...._...._..—
4x 10 10'
402
7'—
402. 12'-0
6x8
14'—
6x8 .12'-0"
6x10
...................... '.-.._
6x 10.........._._......14' .Q.r...
mr'
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE 1994.
UNIFORM BUILDING CODE.
SUPPLEMENTAL NOTES:
WmBi—
........... _.._.
_ _.
.........................................
1.. ..... . .............................................................................
ROOFING NOTES:
A. BUILT—UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
I
n
s
O
`�l
V
4
Q
x
�
N
OWNEW 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' ocial 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 ate 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 Quintax�A 92253
(619)564-2246
FAX -:,(619) 564-5617
OWNER'S SIGNAJ"+TURE/DATE
Y
J
PROPERTY ADDRESS