0105-001 (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 Busine"ss and
Professi6hals Code, and my License is in full force and affect.
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) 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 5 - 1 -70fi! Signature of Owner 4
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-"` 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, 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).
' Y4 I certify that in the performance of the work for which this permit is issued,
Itshall 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
sObject to the workers' compensation provisions of Sect ion 700 of the Labor
Code, I shall forthwith comply with those provisio&s. �` v
Date:C' gam`+� Applicant— � J • _1j
Warning: Failure to secure Workers' Compensation coverage 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, indemnity
& 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 purpoo"ses.
Date
Signature (Owner/Agent)
• -BUILDING PERMIT ?ERMIT#
DATE VALUATION LOT 010.5 -Dol. TRACT
JOB SITE --
APN
ADDRESS
920 CALLF 033ITSPO
'16.0-07ZAW
OWNER
CONTRACTOR / DESIGNER / ENGINEER
GFIZAIM I0; )1R
01MITMRIMMM
X092 0 CRUZ OI3IVIO
I.A. QUINTA CA 92253
USE OF PERMIT
I) Ano
'70'x It)' PA:110 r,0V'FRd[.A T'r1C Z cal FS1U19 T—UP
0 T V STAN DAR D
PC,RC1 YHA d',IO -40,00 iii
Fb^.d'.fMEND COW OF W14MUCIMON
PLAN CHECK IRF' 101.000.4,39.3I8
CONSTRUCTION f' 101.000-418-.000
S'!"Iit.7NG MOTION FEE - Ti RID 101-000-241.OW) S."
a o
F
M AY - 1 2001
SUB. )TIAL COJR&J—@J"J' A11) PT .AN r!IWCK
$193.98
ivv��vv����
e .airy . �WL9 -PAW FI�.['nJ
$0. of)
IWli;L1t ERNI ➢A!°I S DUE NOW
$193.
RECEIPT
DATE !
BY
DATE FINALED
INSPECTOR
�1'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
_
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
t s
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
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 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
COMMENTS:
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)
OWNER/BUIL'DER .INFORMATION
Dear Property Owner:
An application for a .building permit has been subrnitied in your narrie listing yourself as the builder of the property
improvements specified. u
For your protection you should be aware that as "OwdnerJBuilder' you-are the responsible party of record on such a
d by property owners unless they are personally performing their
permit. Building permits are; not,required.to'be;signe
ownwork. If your work is ;being performed by-sorrieone 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 lawstobe, 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 out 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 informatiM 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 =x200.00 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 wuh he`State and Federal Governriment'.as.an employer and you are subject
to several obligations including: State aiid Federal income tax withholding;, federal social security taxes, worker's
compensation insurance; disability insurance costs and unemploymentcompe.nsation contributions.
There may be. financial. risks for you if .you do not"carryout these obligations, and these risks are especially serious with
respect to worker's compensation ;insurance.
For more specific information about youi.obligations under. Federal Law, contactthe 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 licerised'contractors are allowed to perform their
work personally oi.through'their,own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractorsis 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..uriless they.'are performing their own work
personally.
Information about licensed con tractors, may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Streei,'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
78-495 Calle Tampico
La Quinta,.CA 92253.
(760 77-7012
F ) 777-770
OWNER'S SIG
PROPERTY ADDRESS
PERMIT NUMBER(s)
a
0
RAFTER' SIZE AND',SPACING ,�.
'`"''
SPECIFY-ROOFING QNO SHEATHING OR OPEN LATTICE .
r
2> 2y Al C ��
----- 6
--------
(SEE ROOFING NOTE ON REVERSE)
_eOL-Lrr� RODF ¢ lArrlcF Ccorn
":ROOF PITCH
`- Oft' 70 9JR, IN
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZET'
,"AND 'L' STRAPS
6ix6"x1.1xI%6' WITH
----------
z
I (4) 16d NAILS OR BOLT I
z
O
RAFTER SPAN:_
POST SPACING:__
__! ---
_�__
_
O.H..
v
OVERALL LENGTH: 2 _
a
,
,OVERALL LENGTH- 70
X.
3
2'6 " I S
REAR SETBACK ..
SIDE SETBACK:.'
POST SIZE: _
(4"x4" MIN')
—�1 FINISH GRADE
2000 P.S.I CONCRETE I
FINISH GRADE
I {� I I
MIN. 12"x12" FOOTING
a L_J
L_J 12"' BELOW GRADE L_J
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
NOTE
OPEN LATTICE PATIO COVERS MAY BE ATTACHED. Td' EXISTING `FASCIA
VIA ONE 1/4" x 5" LAG SCREW THROUGH FASCIA INTO EACH RAFTER. TAIL.
U=STRAP OR ANGLE
3/8" x 5" LAG SCREWS INTO STUDS AT 1'6" _'O:C.
NON-CORROSIVE PLATE.,.
GRPDE
CONTINUOUS' LEDGER
I I
,
�I
�IL
Fl 77
II
II
(4)- ,16d NAILS
III II
OR, BOLT
U=STRAP OR`ANGLE•
(4)— - 1�6d NAILS
OR BOLT
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
PROVIDE 1" CLEARANCE
BETWEEN AND
..
� I:
BUILDING DEPARTMENT ,APPROVAL,, BELOW ::'
III
III
III
II
III III
ANCHOR BOLT (EMBED...
;.7" MIN. INTO CONCRETE)
CITY OF LA QUIIUTA: .
BUILDING &�SA�FETY DEPT
-
TYPICAL PATIO COVER
' DATE OF APPLICATION
FOR CONSTRUCTION "
OWNER'S NAME
�AI�b Gope
vub
v ((���"�
DATE �' BY.C'
STREET, ADDRESS
SD n v CAtte 06iSPd
CITY. sr ZIP"
LA 9LO W7-,4 1 CA-• 92253
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'TELEPHONE�lJ
I - 2"( (,j 7
H.O.A. APPROVAL
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