0301-226 (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 r
Date 1' Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaratlrons:
( ) 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. 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).
�(jie) I certify that in the performance of the work for which this permit is issued,
Irshall 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 a Labor
Code,; I shall forthwith comply with those provisions. f � `
Date F ..p t .,F, Applicant""
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlaGuf"ul and
shall subject an employer to criminal penalties and civil fines up to $1W000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers,. agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorise representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)f j %'� E •+ f + .? •; f :Date {
BUILDING PERMIT PERMIT II
(A�1.AlN
DATEVALUATION, LOT TRACT
JOB SITE ADDRESS "18- 390 SA Td�..i RI V.G7.
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
MAR Y HER:t*1MDED
C WNT-1i - F-1111Il;...s:)'ER
7S-"7` 0 OqANrrA
ITA Q ;i.JM}) CA 92253
t'
USE OF PERMIT
r4 S F. !..l.T'1ICEP, PAT 10 CCFM CITY at'rANDA RD
PORC:HlPAATO _s7.4,00 SF
`
�v-p�yy�ny �7.MUTA
�9�y{� pp���� PP FEE
S "i.,l�l�i-7 F .77 EE S �LJJFRXi:[L) R H.
i'E ANN i:Dit;C K FEE 101 -WO -439-•33 8 MAO
CONS`I,RUCTIOW FRE 101-000-418-000 M.60
STRO 7O IAO`i'1014 M REBID 101-000-241-000
Q
D
JAN 1 5 1003
tLxjz( i LfJ�' � j1..i�k3T t"� k fY
15 '.?C1
.T.$:SS .�'.fv''�-FAID �
$0,0b ..
TOTAL MM114 TM DUE 940AW
91 WIN,)
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
f ,. e � •,�
Sof l-.�
.
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 APPROVAL '
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
j
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:
4
OWNER/ BUILDER, -INFORMATION
Dear Property Owner:
An application.for a bwilcling permit has been subriiitted in yoir name.lisitingjourself as the bu'llder of the property
improvements specified.
For yourprotection you:should be aware th;icas -Owner! Builder"'you are the:jresponsible'lparty of record on such a
permit. Building pFrmits are not required to be signed,by property -owners urilesi.th - ey.are personAly performing their
own work. If your workiis being -performed by someone othei:`tbanjoUrsel you may protect yourself from possible
liability if that Person . applie.s'for, the proper toper permit in'his , 6r-'he.r name.
Contraciors are required. by law to be licensed and boncledby, the Stati;:"ofCiliforriia ifid to have a business license
�_,are also reqiilr '�e�se,`nurril3er. all permits fo "which they
from the City or*Cdunty. The' required by law to Opt t I h.eif'ylii. on r i
apply.
If you.,plan to do your own work, with the exception of various trades that you plan wsubcontract, you should be
y 1� 1, * - . I I
fr
r enefit and protection: aware of the following ifif6miatidn for y�'6 b
4
y"
If you employ or otherwiselengage.any persons other than 'our imrri'erdikte,fami and work'(Including materials
an& other costs) is $jOO�bOjio'r more4or the entire project, and .1 h persons are not licensed as contractors or
subcontractors, then you maybe an employer.
If you are. an -employer, you mustt-fegister with the"Stafilh ' &FedefaFGovern Government ais.A.n em�16yer -and yqu* are subject
to several obliiitiori�s d Federal1" f 1. . I -. t
State income ding 4 ederil-sociarsecuri taxes, worker's
compensation insurance, 4isiability, insurance costs and unemployment corripprisa.von coritril.idtidn
There may be4financial risks fbi you if you do not carry out these obligationg, aria These risks are especially serious with
respect to,worker's compensation insurance.
er contaei,.tt;e,I6teitikl,Reve.nue Service (and. if
For i-nofe specific infor'mation-aboUt..your obligations und Federal Law,
you wish,,t,he U.S. Small Business Admins.truion);, For more specific tnormation aDOUt Your obligations under State
Piymenis and icle'nis.
Law' contact the Pepartmerii of Benefitc
wners who ` ii 'I;c hs'
If the structure is intended fo,Cia'le, .,property. o are or, i e ed;contracf6rs'a"re'allowed to perform their
it h ac
ugh the :own employees, wit out a d subcontractor, only under limited
work,personally or thriol. lic-e"nst -cqntrac.tor:of,LSU,
conditions.
A frequent, practice of unliiensi'd persons
pTof6ss'!hg-1d,be,tdhtractors isjo,secure an:.'.' Owner/ Builder "i building
permit,- erroneously implying that'the _-.property owritys"pioviclinj'--his--of herown, -labor' and`material, personally.
Building permits are not required to be signed by -property, .-owners unless' -the" rftir " tfg own work
y, are pe mi
personally.
Information about licensed contractors. may be,obtaii-ed, by'reon'ta'c.pbg i:he CPheractors' Stite Lic4inse Board in your
community or at 1020 N;'Streei,�Saciamentoi, California 95814..
Please,complete and return the"inclosed ow.nei-buiidet,v"e�rificta"tion f6im4&,thaf'we can cohfiiim' that you are aware of
these matters. The building pqrmit.will. n*ot-,be issued" -6 icat'io'n-i isie_turne
Very truly yours,
CITY OF LA-QYINTA
DEPT. QF,BUIL6hqG'AND SAFETY
78-495 Calle Tampico " - . V
La Quinta, CA 92253
(760) 777-7012
FAX
,/-(760) 777-7011
OWdER'S`SIGNA /DATE
-78
PROPERTYADDRESS
PERMIT BER(s)
0
RAFTER SIZE AND SPACING
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
_��-� -� 2y__9fi�at= I•'. '
l
(SEE ROOFING NOTE ON REVERSE)
_ 77-ick-----------
ROOF PITCH
a ,
CONTINUOUS LEDGER.
(SAME SIZE AS RAFTERS)
`
HEADER •SIZE .'
'T' .AND 'L' STRAPS
WITH
it
=
i
I (4) 16C NAILS OR BOLT
U
J
1
RAFTER SPAN:6__
POST„ SPACING:-Jl-_-
O.N.
a
O.H.
/
u
/
OVERALL LENGTH: `
O
a
:
OVERALL ,LENGTH:_ 3 q
_
r
Lo
t
0
, ---
%0
REAR SETBACK SIDE SETBACK`
POST SIZE: -Y1j _
4.x4' MIN. )
`C
2000 P.S.1 CONCRETE "
I FINISH GRADE . FINISH- GRADE .
L- -J I
...
I 6- MIN: 12" x 12" FOOTING I I
12' BELOW GRADE L_J
q t
`
PROVIDE 1" 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..
U-STRAP OR ANGLE
, 1.4
3/8' x 5" LAG SCREWS INTO STUDS AT 16" D.C.NON—CORROSIVE
•<�..'
PLATE
pE
...;.
�
GRP
CONTINUOUS LEDGER
7
N
-
" ;ILII
(4)-: 16d NAILS
III II
OR 'BOLT
U—STRAP OR' ANGLE
(4)—. 16d NAILS:
JOIST HANGER OR SOLID BLOCKING
OR BOLT
NAIL RAFTER TO BLOCKING
I
PROVIDE 1".CLEARANCE-
-
BETWEEN POST -• ''N&
'CONCRETE
II I
BUILDING DEPARTMENT APPROVAL BEL01N
it II
II II
6��G� co4
ILII
I
IN
II
AIT/�
CITY OF NN
ANCHOR BOLT (EMBED
! A
LA7ETV
BUILDING &SAEPT.
7" MIN. INTO. CONCRETE)
PROVE®
i
TYPICAL P.ATI,O COVER
FOR CONSTRU N
'DATE OF APPLICATION•
��
///
DA
r
.OWNER'S 'NAME•.
y
STREET ADDRESS
a '1 G Qpy-
'CITY, ST ZIP
TELEPHONE.•
,.
"
H.O.A. APPROVAL
RAFTER SPAN TABLE
GRADING RULES
PS 20-70
(FEET & INCHES) pJ�� (Z) A oJ��
O� O� O� V�`z
cl) c� O
2x4
16" O.C.
24"
10'-6"
i 9'-6"
1 7'-3"
°'—o"
8'-6" 1 8'-0" 6'-0"
7'-3"
DOUGLAS FIR NO. 1
SITE
2x6
16" O.C.
24" "
32" "
15'-0"
14'-0"
10'-9"
13'-0"
12'-6" 11'-6" 8'-9"
10'-6"
10'-0" 8'-0' N/A
N/A
6'-0"
4x8
2x8
16" O.C.
24"
32" "
18'-0"
17'-0"
13'-6"
16'-0"
15'-6" -6" 11'-0"
13'-0"
13'-0" i 11'-6" N/A
N/A
12'-0"
I 6x8
NOTES:
1. 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED TO 10'-0" USING
THIS STANDARD.
LATTICE
ROOF
BUILT-UP ROOF
HEADERS
HEADERS
DOUGLAS
FIR NO. 1
DOUGLAS FIR NO. 1
SITE
SPAN
SIZE
SPAN
4x.4
5'-0"
4x4
4'-0"
4x6
8'-0"
4x6
6'-0"
4x8
1 1 '-0"
4x8
8'-0"
400
14'— 0"
4x 10
10'-0"
402 2
1 7'-0"
402
12'-0"
I 6x8
14'-0"
6x8
12'-0"
600
17'-0"
6x 10
14'-0"
i
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE
1998 CALIFORNIA BUILDING CODE.
SUPPLEMENTAL NOTES:
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 31/12 MAXIMUM PITCH.