0303-172 (PAT)LICENSED CONTRACTOR DECLARATION
O�;,,,
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
104981
„Date Signature of Contractor _^" «-• -• f
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
••as.
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.
StiN ,1) I have and will maintain workers' compensation insurance, as required by
ction 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 STATE FWD Policy No. 1S42937.0.3
(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;l should become
subject to the workers' compensation provisions of Section 3700;of the Labor
Code, I shall forthwith comply with those provisions.
Date:'. Applicant �` n H.•^,. a M, _�
Warning: Tdildre to secure Workers' Compensation coverage is unlawful 48
shall subject an employer to criminal penalties and civil fines up to $100,000,11p
addition to the cost of compensation, damages as provided for in Section 37
of the Labor Code, interest and attorney's fees.
";IMPORTANT Application is hereby made to the Director of Building and Safet
for R rarmit si.0jert to the rnnditinns anrf rastrirtinns Ser forth on hi,
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
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE, APN
ADDRESS gi1.
OWNER CONTRACTOR/DESIGNER/EN (NEER
PO BOX 369 7 a-.15 1) CAME 1"A1;>'t+ PIM 011 � P.,#230
1A QM11TI-A CA 922.53 '000TJ"A�;` CA 922J3
(76 )564.4604 r'131O 2261,
USE OF PERMIT
PAMO
ALSO Via' R i.,15.'P`TiCE,PATIO COVER, PER CITY .RPPFtCitJ'ED PIANS
P01101VPATIO
440,00 2F
FSTINAM COST Ole CONVIRUCTION .5181-9100
la' .s . xar .'fi��. + -g4s'w4kzy
13110 C."'ECKIFER 1. 01 -000-439-3118 $52,65
CKat+NTRUCTi-ON F&I 101-000-418-000 $81.00
MONO MO T101'4 ""FEE. .4 `�lCi 101.000441.000 S.59
L�
�,�►R 19 2003
— -0�t?15INTA
CITY _ r� nEPT
SUB -IMM, MINI iklJL", ION• AND PLAN t" ',Ci5. $134.24
L1415 PRE -PAID .t MUS, $OM
T101AL FRAVOIT PIKES DIT, NOW
J
RECEIPT DATE BY DATE FINALED INS; yl$I
!rte
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4
Underground Ducts
Forms & FootingsDucts
Slab Grade
vReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_l(�. _
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final_ 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)''ines
Water iping
Heater Final
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::' +0,C
t?k lO 867AM
y
I
RAFTER SIZE AND SPACING SPECIFY ROOFING AND' SHEATHING OR OPEN LATTICE --
(SEE ROOFINC NOTE ON REVERSE) '
:I
ROOF PITCH
LCONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
it
HEADER SIZE T' AND ST -RAPS
Lx 'L' ,�, I 6"x6!�x1"xI WIT
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4" x 5" LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
I /n" � S" 1 er cr PMAlc IAITn cn inc wT , c n
-vial VR JVUV CLVl.K11 U
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW-]
CATY OF LA UUIN 1 A
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
i
DATE 8 -
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
7
TYPICAL NATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS L c`
CITY. ST ZIP \ ( \
TELEPHONE
H.O.A. APPROVAL
II
w
I (4) 16d NAILS 0 0 (
I
Z
O
/�
4
cy
RAFTER SPAN: __�
'
r
---
POST SPACING
`t
UJ
O.H.
a
O.H.
_ ___
U
a (
O
OVERALL LENGTH: `
------
a
OVERALL LENGTH:__ j!jL_
POST SIZE:
REAR SETBACK
SIDE SETBACK
(4"x4" MINI)
I
is
2000 P.S.I CONCRETE —moi
I FINISH GRADE
FINISH GRADE
I �— MIN. 12" x 17" FOOTING I I
L _ J
I-- J 1 -27. -BELOW. GRADE L _ J
PROVIDE'l" CLEARANCE
BETWEEN POST AND
NOTE.
CONCRETE --�
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4" x 5" LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
I /n" � S" 1 er cr PMAlc IAITn cn inc wT , c n
-vial VR JVUV CLVl.K11 U
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW-]
CATY OF LA UUIN 1 A
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
i
DATE 8 -
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
7
TYPICAL NATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS L c`
CITY. ST ZIP \ ( \
TELEPHONE
H.O.A. APPROVAL
II