9808-105 (PAT)H
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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# Lie. Class Exp. Date
Q, 6
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
x) 1 am exempt under Section B&P.C.for this re Slod'b
Date b /l " Signatureof Owner ,k `�ti j'G:�
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:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
X 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
RUB, I s aIlrforthwith comply Wi h,thos provisions.
Date: r'j,. APPlicanf, r L ,Nt.'s
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. y
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.
i�
ignature (Owner/Agent) Date
PERMIT"°NTR°`#
BUILDING PERMIT
y23i3�- l f}G
/
DATE VALUATION $2,194.50 LOT TRACT 7473
JOB SITE
ADDRESS 53-5$5 AVENI DA C:(}.>tlTEZ
APN
0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K.r-A'i t1,EFWS ;WI4.EEL2R
OWNER SURICIER
53545 AVENWA COWPEZ
LA QUI N'I'A CA 92153
USE OF PERMIT
C=rNRkM, BUILD NO
1167 .`'iilYY LATE 1C F1. X.10 COV'i�;R.
I ORCIVPATIO ItiS.Or) :i17
74ST [ VIA -C ,,D MST OF C'ONSTRUC IC NII
x,'194.50
PEANUT FEE SUMMARY
PLAN CHECK. FFF. 10
c, ONA1.'f'RUt TION FIT 11)1-(3 )0-4 i Vlflo
STRONG FEE - RE310 101-000-2-11-00
AND PLAN 'T1?,X
LESS 1R♦ FCE i
�..i0rn
`µ?2.'0
-1,A11
Y�
AUG 1 � 1998 'FOTAI., PFRMIT FEES POP'NOW
�iTY 0 17 LA QrU1N IFI
RECEIPT
DATE b
B
DATE FINALED
INSPECTOR
INSPECTIOO N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 4
Underground Ducts
Forms & Footings ei /1
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
BLOCrK4 ALL APPROVALIS
POOLS e 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
Lav Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Fieeal
Utility Notice (Perm)
COMMENTS:
RAFTER SIZE AND SPACING
CONTINUOUS LEDGER —�
(SAME SIZE AS RAFTERS)
HEADER SIZE
_fixb_-W_tI
01-11
ROOF PIT
�%
--i3i k -
ANER44uG- my
ptao,4 * A-
9. l�Tb sEr3ak
0:+1
f,c.AR 3ETBACK
Tn/w�
CISH GRADE
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING N TE ON REVERSE) •
----- NIA--------
7
'T' AND `L" STRAPS
6"xW0"0/8" WITH
(4) 16d NAILS OR BOLT
U
POST SPACING: --- Wc
O:H.
L 14AV, 94-6.0,10 11
11 OVERALL LENGTH:--
_ q _D POST. SIZE:.__ xLL__
SIDE SETBACK (4"x4 MIN.)
v n FIH GRADE
2000 P.S.I CONCRETE —+I i I NIS1 4-- MIN. 12"x"12" FOOTING I' I
vjL_J L_J 12" BELOW GRADE L_J
pi�o vio M vatm I i1 i_ e-vn11V Ecru oN Tw
WM -- �b
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4 x S" LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
BUILDING DEPARTMENT APPROVAL BELOW
c.f f y F 1_A Ul"1T R
BUILD., :,r� ,SAFETY.
ENT
h
l J1V7 PER-LATION A`
AI ID ALL APPLICABLE CODES
%Pi%tj� �%LLLYa%
� Lam"//�► � -
I
U -STRAP OR AN(
NON -CORROSIVE
(4)- 16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE —�
U -STRAP OR ANGLE
(4)- 16d NAILS —
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT (EMBED
7" MIN. INTO, CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS
CITY, ST :ZIP
TELEPHONE
H.OA APPROVAL
RAFTER SPAN TABLE
�, .LL 'CONSTR.UCTION. SHALL CONFORM
GRADING RULES �-� �� C.) � �Cl.)� � �� TO THE. PROVISIONS OF THE 1994
PS 20-70 C� c�
(FEET & INCHES) o�`� oJ�' of `� , ;� UNI,FORM BUILD.IN,G CODE.
Q9) O,�i. O
IV
6 C-5
2x4 16" O.C. 10'-6" 9'_6^ 7'_3°
NOTE:
32" O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY.
LATTICE
24"
BUILT-UP
ROOF
HEADERS
HEADERS
DOUGLAS
8'-6" -8,-0" 61'-0"
7'-
NO. 1
SIZE
2x6
16"
24"
32"
O.C.
"
"
15'- "
14'-0"
1�'-9"
13'-0"
12'- 11'-6" 8'-9^
10'-6".
10'-0" 8'-6" N/A
N A
4x8
11°-0"
2x8
16"
24"
32"
O.C.'
"
"
18'-0"
17'-0^
1.3'4"
16'-0"
15'-6" 14'-6" 11'-0"
13'-0"
13'-T 11'-6" N/A I
N/A
14'-0"
6x8
NOTE:
32" 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
5'-0"
4x4
4'-0"
4x6
8''-0"
4x6
6'-0"
4x8
11°-0"
4x8
8'-0"
400
14"-0"
4xi0
10'=0
4x12
17'-0'
402
12'-0
6x8
14'-0"
6x8
12'-0"
600
17'-0'
600
14'-0"
SUPPLEMENTAL NOTES:
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
� .. .. .�.Vf'�l^a�•-: �f-y-.r et,w/'t ._'1 �"V'�+'�..r•=-...7^� "*r%v.+Y 6- `l:�t� � ti4 �v Y'ij. ��1-s -�:^ a• ice„ v:v -n`i. ��_ f r
t
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are'the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing 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. ,t
1
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 their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades ithat you plan to subcontract, you should be
aware of thefollowing information 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 $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 takes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There maybe financial risks for you if you do nor carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
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.
If -the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally, or -through their own employees; without a licensed cpntraetor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permi, 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 unless they are performing their own work
personally.
Information.about licensed contractors may be: obtained by contacting the Contractors' State License Board in your
community or at 1020 :N, Street, Sacramento, California,95814.
Please complete and return: ihc- enclosed owner=builder verification form so thavwe can -confirm tktat=you, are aware_ of
these matters. The building permit will dot be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
la Quina, CA 92253
(760) 777-7012
PAX: (760) 777-701° "'
OWNER'S SIGNATURE/DATE
PROPERTY AD SS
MPT NUMBER(s)