9605-154 (COMB)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
Cod.. 1
U,A am exempt under Section , B&P.C: �fo',, hit reason
,Date < /e u ✓ 1 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.
(, )/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-th�oSe pfo„esions.
{Date: 14, � ! IL Applicant/--
Warning: Failure to secure Workers' C(mpensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property,for inspection purposes.
l 4t
t,Signature (Owner/Agent) Date.�a
PERMIT # CONTROL #
BUILDING PERMIT
960.5-1.54 3390
DATE !VZ4)yfp6 VALUATION � � LOT TRACT`
JOB SITE
ADDRESS St -14:5 t:.t15�1X (�l r10
APN ;7551 .t34-tlti7 - I
OWNER
CONTRACTOR/DESIGNER/ENGINEER
a,. i11' OL i e`i S (311 .1.
51145C;,'!iL1 RQU00
LA Qi,.f.19FA CA 42253
C1A1.11
USE OF PERMIT
(Q'?fV.i?.I�fll. Itilj;,i.liMli
1r4")t$R PA't'10 t*ryt+ S 1.Nrt'l(ti, Rm c)C'K 4040 W1N1X.)W INSTALL 8(00 WIAfD0W i.'-ITOJEN
3i1? W1ttt, M !1'4'i t>i T:).7>f,`gltlf ,�1, iiN� 7,cfgi S '!'i 1�'tOlt WA'1:t5t tiTsA'1 f?R, P1JjM13 FQR 6 CA3
APPLY.A14CFS. f? MER P'btO1rlDEMi WLiRF, MAINS COIN411 AND Si!fff.lRT 149F 1t1 Q1J11dM
F'ORCr` KIAT10 ?17 N) S
1+ nS'y'ihl,l:li'N1) (:'l>4'1.' OF i.d NS4'R1,X t'.Hf1,q
!'E}tMIT 6'FF, �r`C)MMARV
PLAIN 011:1-7Y FEE Iif! -00-41,119-318 i tt .LC
1 4., 101»000-419-000 $72.Gir
N t +Nt ; M(Y I tON t Lti - RF11 11) IM tHK)-24t-tk.81
f.:1.#iCtltft X11 f/H : 1t}1 -000.41211 -WO
rn �
IIIX.1!?it'e'(I FIEF; 10!40-4119- f3•"5
•
c�2
i E �— Ix
:11113-'1 I"A1. COIN4MKIL (.111 N ANIS PLAN C'11RXX
$1.45 0
i.liSti PRE r1'Attil�fsf:5!}t}t3
1, V PAIT FF,E+i 1)11 fa NOW
$145.019
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 A,
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
unlis
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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 Nottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Poyer
Final
Utility Notice (Perm)
COMMENTS:
/G'y
9 .
OR OPEN LATTICE
d. RAFTER SIZE AND SPACING
SPECIFY ROOFING AND 'SHEATHING
ROOFING AT LEFT)
EE NOTE
JI -Ti , -----
ROOF PfJCH
CONTINUOUS LEDGER
T AND 'L' STRAWS
I
H ER SIZE
I Gx6'x1'xt/8' WITH w
I (4) 16d NAILS OR BOLI
210 2 O
N� POST SPACMd Itov
RAFTER SPAN:
O.H.
w
O.H- v
a
OVERALL LENGTH: I
' OVERALL LENGTH .
-�.
MIN. 4x4'• POSTS io
REAR SETBACK
SIDE SMACK'
'
FINISH GRADE
2000 P CONCRETE —
FINISH GRADE
L� J — MIN.' 17'x:T FOOTING L� J
-S-1
L- J
I
17' BELOW GRADE
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
U -STRAP OR ANGLE
NONCORROSIVE
3/8" x 5 LAG SCREWS INTO STUDS AT 1
O.C.
CONTINUOUS LEDGER
Y
(4)- 16d NAILS
OR BOLT
U -STRAP OR ANGLE
.. ................ ...
(4)- 16d NAILS
OR BOLT
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER To BLOCKING
ANCHOR BOLT (EMBED —� PROVIDE 1' CLEARANCE
7' MIN. INTO CONCRETE)' BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT .USE ONLY
TYPICAL PATIO COVER
PERMIT NUMBER
DATE OF APPLICATION
PERMR ISSUE DATE
OWNERS NAME ,
FINAL INSPECTION .DATE
STREET ADDRESS
SPECIAL CONDITIONS
CITY, ST ZIP
TELEPHONE
H.OA APPROVAL SIGNATURE. DATE
F7RAFTER
SHEATHING OR OPEN LATTICE
ZE AND PACING
�% ,�}r 11
L
SPECIFY ROOFING AND
(SEE NOTE AT
/RROO�FIINyGq
` ROOF PITCH
>r1 • • . •
. . . ........
CONTINUOUS LEDGER
HEAD SI
T AND 'L' STRAPS
I Orx6'x1"xt/8 WITH I w
( U , H
D D
w
�
(4) 16d NAILS OR BOLT
( I I�I I
RAFTER SPAN:
POST SPACING. I
' O.H.
' L
'
w
a
O.H. r ' V
L� �
OVERALL LENGTH:
( OVERALL LENGTH•
I
O
MIN. 4 xC POSTS io
/. REAR SETBACK '
SIDE SETBACK-
FINISH GRADE
2000 P.S.I CONCRETE —+1 1
FINISH GRADE
1 6---- MIN. 17'x42" FOOTING L_J
1T BELOW GRADE'
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
`
U -STRAP OR ANGLE
3/8' x S LAG SCREWS INTO STUDS AT 1 B' O.C.
NONCORROSIVE
CONTINUOUS LEDGER
' v
(4)- 16d NAILS
OR BOLT
�.�
U -STRAP OR ANGLE —V
(4)- 16d NAILS
OR BOLT
JOIST HANGER OR SOLID BLOCKING .
NAIL RAFTER TO BLOCKING
ANCHOR BOLT (EMBED —1 PROVIDE 1' CLEARANCE
y' MIN. INTO CONCRETE) BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT USE ONLY
TYPICAL PATIO COVER
PERMIT NUMBER
DATE OF APPLICATION
PERMIT ISSUE DATE
OWNERS NAME
FINAL INSPECTION DATE
STREET ADDRESS
SPECIAL CONDITIONS
CITY. "ST ZIP
TELEPHONE
\H.OA APPROVAL SIGNATURE. DATE
3 t ,/�N
ROOFING AND SHEATHING OPEN LATTICE
S E (�C
SPECIFY -OR
(SEE ROOFING NOTE AT LEF_r)
f
iROOF ljH
„S` >�� � • • • •
--.fj-^--
,� ...
CONTINUOUS ROGER
T AND 'L' STRAPS
I
H EAD SI
I lrx6"x1'X1/8 WITH W
0
_
( 1 (4) 16d NAILS OR BOLT I !
2
RAFTER SPAN:
POST SPACMC
( O.H.
. ' v
O.HCL 2E
OVERALL LENGTH:
a
r/ OVERALL LENGTH
1.
�I
I
MIN. 4.x4" POSTS io
:`. REAR 9ETBACK
SIDE SETBACK'
,
%,. FINISH GRADE
2000 P.S.I CONCRETE•�� 1
FINISH GRADE
1 1.-- MIN. 12"x7' FOOTING L_J
L_J
I
1--J 12" BELOW GRADE
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
U -STRAP OR ANGLE
NONCORROSIVE PLATE
3/8" x 5 LAG SCREWS INTO STUDS AT 16'
O.C.
CONTINUOUS LEDGER
v
W- 16d NAILS
((f� BOLT
�.�
U-STRAP OR ANGLE
(4)- 16d NAILS
7JO.ST
OR BOLT
HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING-
ANCHOR BOLT (EMBm PROVIDE Y CLEARANCE
y' MINN. Iwo CONCRETE) BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT USE ONLY
TYPICAL PATIO COVER
PERMIT NUMBER
'
DATE OF APPLICATION
PERMIT ISSUE DATE
OWNER'S NAME
FINAL INSPECTION DATE
STREET ADDRESS
SPECIAL CONDITIONS
CITY, ST ZIP
TELEPHONE
t
H.OA APPROVAL SIGNATURE. DATE
RA[tR ZE AN PACINGG
DL
SPECIFY ROOFING AND: SHEATHING OR OPEN LATTICE
(SEE ROOFNG NOTE AT LEFO
--------------------
ROOF PITCH
, r >�1� �< • • • • •
CONTINUOUS LEDGER
HEADlr
T AND 'L' SRAPS
I WITH
lrx�16d xNAIL`
w
*
(4) OR BOLT
( I
�J
RAFTER SPAN:
FT
POST SPACW-
O.H. w
a
Qi
O &
O.H. ( U
OVERALL LENGTH:. '' I
•-//�
.. ' k OVERALL LENGTH:-- io
I
� (nJ MIN. 4x4 • POSTS io
%. REAR SETBACK
SIDE SETBACK
t
FINISH GRADE.
2000 P.S.I CONCRETE —
FINISH GRADE u
L_ 4� MIN. 17'xt2" FOOTING
L_ j I
1f BELOW GRADE L_ J
PROVIDE I' CLEARANCE
i
BETWEEN POST AND
CONCRETE
U—STRAP OR ANGLE
NONCORROSIVE PLATE
E 3/Li' x 5 LAG SCREWS INTO STUDS AT 1 G' O.C.
CONTINUOUS LEDGER
v
(4)— 16d NAILS
OR BOLT
U—STRAP OR ANGLE —�
..
���
(4)— 16d NNLS
OR BOLT
%
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO. BLOCKING
ANCHOR BOLT (EMBED PROVIDE 1' CLEARANCE
T MIN. INTO CONCRETE) BETWEEN POST AND
CONCRETE
BUILDING .DEPARTMENT USE ONLY
TYPICAL PATIO COVER
PERMIT NUMBER
DATE OF APPLICATION
PERMIT ISSUE DATE
OWNER'S NAME
FINAL INSPECTION DATE
STREET ADDRESS
SPECIAL CONDITIONS
CITY, ST ZIP
TELEPHONE
H.OA APPROVAL SIGNATURE. DATE
x
-
Ers ,,� ���
i
5-1
1
CN
r r �loq r T:lAti-
SUBJECT TO INSTALLATION AS PER
i
S rC'O
' S r l
�
�
Fc,,, r rrr7
-
-- :.i� -7'f:0F LA 0111 TA
F _ << 4G & SAFETY DEPARTMENT
i
CONDITIONALLY
A;CCEPTED FOR -0O3 TFfUVJl0'd
SUBJECT TO INSTALLATION AS PER
i
AND ,4LL APDL iCAPi. �; C) )ES
e
01-
a
Q
�
C'4rolyAl U41 6,
CITY OF LA QUINTA
`--;UILDINC & SAFETY DEPARTMENT
comDMONALLY
NSTR�JG'N .
ACCEPTED FOR I
Sl1aIECT TO INSTALIATION AS PER
_ C'� �o /y,v UAL •
K, Tc e r✓ ��e c - ���. ti
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F/90 ►'
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New
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CF Ole c9r
ro A.A P
CITY OF LAG�,IRA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED EORMNSTRUCTION G;
SUBJECT TO INSTALLATION AS PER
`
AN9 ALL APPLICABLE CODES
C. `.iE s ��j BY
' Certificate of Compliance; Residential
(Page 2 of 2) CF -1 R
ProNci rlp:
a�
HVAC SYSTEMS
Nota: input n� K « comoano nlMMC data ur, Wabr (ieatutq sylams. sampt 066w
Heawq L.M.
Neat E Distribution
't'9 Wivment- Minimum Type ano. Duct or
Type (furnace. heat Efficiency location Piping
umo. etc. i
Thermostat
rAFUElHSPFl ductwaurc. sic. t R -Value
Type
r ,,
Cooling Equipmern Minwnum Duct
Type lav co
Worrier, Efficiency location Duct
goat oumc. evao. 000knor (SEER) antic. etc.( R -Value
Themtostat Configuration
T
soIJt or oacka e
WATER HEATING SYSTEMS
-
Water Heater wed' Tank
T Rated'
Number Input (kW Capmty
Type.Standby,
Energy External
Faccr or Tank
Recovery Insulation
in S stem or BtWhrt 1 Icons
Efficien LOSS -(9a,) R -Value
t. For aNno Yu ekWsea lratad npuc S 75.000 8d+ft, atsotiletR �asar Aaatwa. ast Enrrrp�, :aebr.
+Ma MMING �wuc a
Fa 1w" " �s�*18w NtM
�
73.Oo0 8e
p
1. hit
Inumta+wees gas waw. w e. kat Rahwnd input and gsoovary Ear %army Eftwxy am Stwwbr Lou.
SPECIAL FEATURESIREMARKS (Add extra sheets it necessary)
COMPLIANCE STATEMENT
Ths c"Eme of comptwioe IWS ttte tx,lding (sada and peAonnattce s0ec�trcations needed ro (torn
Ne Caitomra Code of cry>M>st Title 24. Parts t aro P, of
"IdWual (Nth overall Re��, and ttte aorrtRuspraltve regtsatgns m onptsmentthem. This aertit><M has (teen W;Md by fie
aril (pons, destgt resbonsiotiM. When nue CROM1e of oompMON a subnvRed for a age putfd V plan m be built in mtdDple
irt)r sftasii V beau(*Nat Is vaned a 9 0MM in me Speoal Feadre&Rematks section.
(womm uef (dab)
Enforcement Agency
f4a,n.:
Ttia:
TiWOhme:
(tnaturaaampt Idabt
Documentation Author
MOM:
TitisrFim,:
TaMphana: pp pp
,i E �.. TT g,r�aa D �. `8 R G i1vi
it+gnaautt , �.�����'� ., �rM "E`� .C�•'?'r PF:::. -(bleb)
f res`,{: �i
j �I-C l ! �'::..:•o.%p-f`- {QRS i, i r
AND ALL APPLICABLE CODES A
� �!/i I ; .