9702-010 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of per jury 'that I am licensed under provisions of
Qhap%y 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
L nse 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 exempt under Section B&P.C. for this 'reason t
/ Date : rr " 4l Signature of Owner ,,�J � kt4,: E v �.
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.
`k 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 G-n,Vt^�ij Policy No. t4541
&5`% % '
(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
sul�Ljqct to the workers' compensation provisions of Section 3700 of the Labor
Cede l shall forthwith comply with those provisionSV
I ate J. 'NI -'i. lApplicantV`Xi�3" 1 V
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 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
th Xbove-mentioned property, for inspection pdrposes. _
Signature (Owner/Agent) #. F� Date`'
PERMIT # CONTROL #
BUILDING PERMIT 4673
DATE.
VALUATION g�y:iiD.S3:� LOT TRACT
JOB SITE APN
ADDRESS 7.9-.11%00C0'Ii.,1LL J .0R1VK .
OWNER CONTRACTOR/DESIGNER/ENGINEER
8ORGIRINIES.WILLIP I.YNICf AS.
P-0. BOX 12M6 79 - 120 ocartL110 OR
PALM DESf?RI' CA. Q'2.53 LA QUiNIA C.A. 92-253
f la I qyW' -0731 CBL#1
USE OF
10' x d0' 1.A'i Y.' dl PATtO COVilt
t��e z��. s•t;.t�.f,'i.ra�
400.00 SF
ir'+�Y�f1�J,t'Y.i. �f LV,ba �.1� �t1AfrY�9♦t7V..%lniaT
t'1'.,AN0EE(,'f•: M 1di1-(li)0.439--318 $52,65
f,: �: N4141110 K;mr"q V (V }tit .W►C1..419-4)0() $&1.00
:Yt'0'N.U- MC01. ON PEN, RE 31L) 101-QtlG-24.000 $33
1AISS 11194-PAM11L.,
TOTAL PURAUT FRES 01311 N -0w,
RECEIPT � �. � I DATE . BY �� j�� i I DATE FINALED, INSPECTOR
$114.18.
.
$•0,130 .,
5134.18
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 — Q — ,
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 APP OVALS
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
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:
_FEB 05 '97 09:59AM SCIF SK CERTS P.1i1
,..:TA P.O- BOX 420$07, SAN. FRANCISCO, CA 94142-0607
.. CERTI IGS TE OF lPVc�RICERS' �^ON�€'ENSATION' INSURANCE
S., 19-97 POLICY NLIMBER;11
ccH rlF1C;ATE EXPiR S
0•r' LA... U.T, NTA
13 U. t,.7 ' SA,FE Y
X 15. 0
L CA 9225.?
Thi: is to cerci`,• that we have Issu=rt a valid Workers' Compensation insuranra policy in..,-. form apprwcd by.fhe Califorhic?
Insur. nca Lcthe, emp!cyer na^;cd below fcrthe policy perlori indicated..
Thi:: pc',: is :got sut'j; %J•`.•to can^-cl a ion by the Fund except upon ten days' t:�>.nnce wrtt�ri notice tc the employer...'
VUc n'ilI alsa•giva you TEN. clays' advance notice shculd this policy be cancelled prior to its.normal'e#p r&;bnr'
"This cert,fica!-r.c` msurancc is nut•ao snsurance po!:cy and does not amend. extend. or after the d6vc-rage"aff�rdc by the .:..-
"; •^•,S. h list;:^- he7eln:' NaMith^c nd'n�' d t+ tit?r -d6c-,' irr ant••w;t
�:��� any requircn^erii; term, or.- eon ; .�^ of an;..co•r: ,"acs` •:crot{'
-respact cerfific� ; • of insurance may be issues': 'or may pertain. the' insurance..affo�dzd..Gy'.a;,;e •poi!e;ry?a :
aesc ccc, na, cin is suL;ect to all d he tc, ms; exclusions ar.d conditions oi'such po!tcie.,:
"°.0 -A`-;': RFPRES'LNTATIVC• .. .PRGS:MI.7T
Ei:FLOYI~ 'S. LIAEiLI'1'Y LIMIT. INCLUUINC DEFENSE CUSPS: $1 ,'OOu-,QUJ. P :1:•:.00CUFRFNC3
•. � 409 (�5(Q —��2� e�eJ .2����'? �, 'r�t� �I�� �tt�L �.�::... •
G(1�iE: �FiC jTUCpmdr— ATi0 CaVEe- L) cif A�t$G{ft-l'
EMPLOYER*
W7 L1 r. ..-LY"..T .A.! D L.[ -Y ;;CANE
9 DA
WAFTER SIZE AND SPACING
ROOF PITCH
CONTINUOUS LEDGER O s
HEADER SIZE p
RAFTER SPAN. /1w
O.N.
2000 P.S.I CONCRETE
/G
REM SETBACK ' SIDE
M GRADE FOM
SPECIFY R00/MG AND 94FAYHoo OR OPEN Lance
(SEE ROOFING NOTE ON REVERSE)
Sc
GRACE
`'t' ANC •L' STRAPS
I lrxlrx"'x1/fi WITH
I (A) 164 MANS OR BOLT
I
POST SPACMiG•
O.H.
,
OVERALL lisllGiH
MR exr PO SITS
m
a_
MN 1 r x, r FOOTM
Li
1 r BELOW ORAM
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO DUSTING FASCIA U-~ OR ANGLE —
VIA ONE 1/r x r LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
NOH-COIM OSIVE PATI
3/S' x r LAG SCREMS IMO STM AT M' O.C.
CohmhMOUS
OR OOITd 'pN.i
IL_ I
U -STRAP OR NME
MOO OO MAU
PROVIDE 1' CLEARM10E
BETWEEN POST IMO
CONCRETE
• - r . �. - . • `II�� ill
PROME 1' CLEM NCE
i r YIN. INTO OONCId:Ti) BETWEEN POST AND
CONCRETE
�A P
U41,14i I TL TYPICAL PATIO COVER
LINo JL