9608-021 (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:
,N 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, a5 Omer Of 11165 pr6p6 ty, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & 'Professionals
Code).
O I amexempt under Section , B&P C .for this reason
Date Ci 11-1 .-Signature of Owner�Y���
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).
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: �t ". ,6Applicantr
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 persbn 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/Age )� 1-1- " ° — �*" 1--6 . Date
BUILDINGPERMIT PERMIT# CONTROL# ,
3833�r'
DATEVALUATION +rTA�1D LOT TRACT
JOB SITE 79-680 000T11L1VO D&
APN
ADDRESS
r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
� o>3r1 . z t. Mj rtA
0'%V.N R 1 8VFU1)E.K
79-080 OCO" LCO :i` R_•
LA, QUINTA CA !9.225
77�..i331
01LO
USE OF PERMIT
LNr1'1(:13.PA310 COV1 1i
Gn.1 CTT!
EST NIATE1 ;i .55.0;` t:.'0N'S'J'R6Xt'tON1 •
7
6,916.00
illIA'N C`0-.ECK FX 1.01.{1W,439-31 H
MAI
"TONG MUTION r>> -M -1 :: fIa aoi-wo-2:rt�O{@ .R�a
USS TRE -PAW x js' S
$0.00
f r'd2 659&P +R i +; 0i. ,t�OW
$149. 19
AUG 0 5 ffl%
By
-
RECEIPT
DATEBY
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
.POOLS - SPAS
BLOCKWAL
AP ROVALS
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)
RAFTER SIZE AND SPACING
� X b .92
SPECIFY ROOrM AND SHEATHING OR OPEN LATTICE
(SEE'ROOFING NOTE ON REVERSE) 7
/„
-------------- crtry
4—f vfL-
ROOF PITCH
• • •
CONTINUOUS LEDGERIM
't' AND V/STRAPS
HEADER SIZE
lrxrxllI I
xWAS
4) 16d OR BOLT I
/RAFTER SPAN: IDr vT, 2 fT
POST SPACMG• 17
O.M.
O N.
12
OVERALL LENGTNF g46' rr
OVERALL LENGTH:
3or rf
r rt ON. CPOSTS m
REM SETBACK
SIDE SETBACIK
,
FINISH GRADE
2000 P.S.I CONCRETE
FINNSH ORAOE
INN. 11rx11'' FnOTNO
� I
1 r eELow GRADE
PROVIDE I-CLFJIRANCE
BETWEEN POST AND
lIGIi:
CONCRETE
OPEN LATTICE PATIO COVERS MAY BE AT #*= TO EXISTING FASCIA
VIA ONE 1/,C x S LAG SCREW THROUGH FASCIA IMTO EACH RAFTER TAIL
U -STRAP OR- MIKE
NON -CORROSIVE PLATE
3/jr x S LAG SCREAMS ROTO STUDS AT 1Ir O.C.
s .
CONTINUOUS LEDGER
WJL
TS
OIE BOL
U -STRIP OR AIME
`���
NAILS
•�`
dE BOLT.
JOIST WWGER OR SOLD BLACKING
NAIL RAFTER TO BLACKIMG
ANCHOR BOLT (EMBED PROVIDE 1' CLEARANCE
T M. INTO CONCRETE) BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT USE ONLY
TYPICAL PATIO COVER
PERMIT NUMBER
DATE OF APP=TIOt+1
PERMIT ISSUE DATE
OWNER'S NAME
FINAL INSPECTION DATE
WREST ADDRESS
SPECIAL CONDMTIONS
-
MY. ST ZIP
TEL,EDNIoNME
.
HAA APPROVAL SIOIlMTURE. OATS
RAFTER SPAN TABLE
GRADING RULES T 03
PS 20-70
(FEET &INCHES) O°J�� opJ��,, O�
2x4
16' O.C.
2e
10'- '-Ir I 7'- '-
5�'-
2x6
16" O.C.
2e
32' '
' ' '-
1 '- 11 1�'-_
1 '- '-NIA N A
DOUGLAS FIR NO. 1
2x8
16' O.C.
3Y
1 '-Si. »'-Si. All.- .1.�'.-4r..
..1.l'-......11....
ALL CONSTRUE ►nON SHALL CONFORM
TO THE PROVISIONS OF THE 1994
UNIFORM BUILDING CODE.
5UVVLLMLN IAL N.J 1 t1:
NOTE:
3Y 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
`
46
69-
48
_..._........._.1.1'-
48
___-�--
410
1 '_
400_
101-
4x12
4x.1
402
. 2'-
.6x8
14'-
6x8
12#
'6x
10
60
......................1. .'.-.
600.
.._ _ _. 14w- _
l
'A. BUILT-UP, R `-RO�DF:TORAJ.r,._--
B. ROCK ROOF:.3/12 MAXIMUM PITCH.
TAh
CV
oF 1°wS 78-105 CALLE ESTADOr — LA QUINTA, CALIFORNIA .92253
t
TELEPHONE (619)156,4-2246 FAX (619) 564-561.71
OWNER/BUILDER, INFORMATION �+ ,
Dear Property Owner: _
An application for a building permit has been submitted in your name listing yourself as the wilder of the property
improvements specified.
For your protection you should be aware that as "Owner/ you are the responsible.pzrty of record on such a
permit. Building permits are not required to be signed by property owners unless they are.perwriallyperforming 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 iheir-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:
Jf you employ or otherwise engage any persons other than youi.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 social 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. ;A
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 State
Law, contact the'Department of Benefit Payments and the Division of Industrial Accidents.
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Ans
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