0108-234 (PAT)LICENSED CONTRACTOR DECLARATION
Ihereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 5 (commencing with 5ecti6h /UUU) of UiVision 3 OT The BUSIneSS ana
Professionals Code, and my License is in full force and,effect.
License # LiaSa
Clax Exp. Date
Date j Signature of Contractor
OWNER -BUILDER DECLARATION
:tna4
I hereby affirm under penalty of peridiry•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).
(,k). I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals"
Code).`r
O I am exempt under Section , B&P.'C.'for this reason i... ..
Date ... T 01 Signature of Owner
WORKER'S CO
,I; hereby affirm under penalty of perjury one of the foll'o'viing 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,
1 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 sh6ld become
subject to the workers' compensatiojprovisions of Section 3700 of the Labor
Code, I shall forthwith comply with' those provisl ns.
Date: 4 Applicant -
Warning: Failure"ta-seoure•-Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties -and civil flnes.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
the above-mentioed property for inspectiontpurposes.
Si nature (Owner/Agent) �!�•�•-- r �s h a_ , _ _ .Date 7 a.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (AW234 TRACT
x3{ 41 �y q p.y /fig
JOB SITE
APN
ADDRESS
-4-5-495 9 MMOROCNIC LAM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LOUAY XBOURY
OINMR, BU DER
45-495 %W_ . ?Rrt^1K L"
'a..f3QUANT A. CIA (12253
USE OF PERMIT
?AT`
e
540 1319 TRLYLVS PATIO (3 /'r61. PM CITY STAXIMR0 '
AUG 2 3 2001
C
TY OF LA QUINTA
FINANCE DEPT—
PORC:IMPATIO 5540,00 ZP,
PLAN ME= FEE 101 -000-439-3) re
C ON'S RUCTIIOtd ISE 101-0001-418-000 $99.00
STRONG MOTION tZF RUID 101-000-241-000 $172
WS -TOTAL 00149 .P.T tt' N liND : 'L. 9 (311?CK
$1164.01
JUMS PAYD FLS
$0.00
r 6
DUE
`' d4an.&Y,l71HA .7-"�lam*R f 8{.1:x31.551 DS+YE NO W
A
RECEIPT
lip
DAT>
BY
D 1NA D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs cC
Underground Ducts
Forms & Footings (� z �� U
Duds
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing `�f=�/?''"
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
PartyjWall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final=�. (
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I I
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 SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
L x 6 /J ZLf 10" (SEE ROOFING NOTE ON REVERSE)
-----------1-- -------------------_ `
` ROOF PITCH
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA OUINTA
BUILDING & SAFETY DEPT.
A
FOR CONSTRUCTION
ATE �/ BY�
D
(4)— 16d NAILS
OR BOLT
U—STRAP
CONTINUOUS LEDGER
(4)— 16d
NAILS
OR BOLT
PROVIDE
1". CLEARANCE
BETWEEN
(SAME SIZE AS RAFTERS)
CONCRETE
HEADER SIZE
I 'T AND 'L' STRAPS
6'x6-xt"xt/8' WITH
I
/
(4) 16d NAILS OR BOLT
RAFTER SPAN: ---
POST
SPACING:
ff
O
O.H.
v
OVERALL LENGTH: ._
a
/
OVERALL LENGTH
~
POST SIZE:'
REAR SETBACK
SIDE SETBACK
(4"x4" MIN.)
1°
2000 P.S.I CONCRETE —moi
;FINISH GRADE
FINISH GRADE
L. _ J
�.I J— MIN. 12' x 12" FOOTING 1 I
I
/12" BELOW GRADE � - j
I
PROVIDE 1' CLEARANCE
r
BETWEEN POST AND
N T
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
CONCRETE
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 16" O.C.
f__CONTINUOUS LEDGER
NON—CORROSIVE PLATE
P
(�__' JMiS� R
�I
E
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA OUINTA
BUILDING & SAFETY DEPT.
A
FOR CONSTRUCTION
ATE �/ BY�
D
(4)— 16d NAILS
OR BOLT
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.O.A. APPROVAL -
OWNER/BUILDER INFORMATION
Dear Property Owner:
a
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 "Ownea/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed br 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 1 -is 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 laa' to put their license number on all permits for which they
apply. l�
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:
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 employerand 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 uremployment 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.
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 wEo are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner .s 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 the enclosed owner -builder v-rification form so that we can confirm that you are aware of
these matters. The building permit will not be issued unr:l 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) 7
U12 > •.
F""Jf6)1
O R'S SIG A RE/DATE
ys X95- Std, �rdvk Ln
PROPERTY ADDRESS
0
PERMIT NUMBER(s) .