0306-480 (MISC)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:
() 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 contacting with licensed
contractors to construct the project (Sec. 7044„ Business & Professionals
Code).
( ) l,am exempt under Section B&P.C..for't4is reason
.Date i k I <,' Signature of Owner A 1,f t ./
k, ' A4 it ,
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 I should become
subject to the workers' compensation prdiisionsjof Section 3700 of the Labor
Code, 14 forthwith comply with those provisions.
Yate: d �.�; it-^ Applicant�;4,�
` t, f. , 14' .) `�
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, damagres 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 lall 'City. State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propert'y,Ifolr in�pelctionfpurposes.
Signature (Owner/Agent)��1 Date (�
BUILDING.PERMIT PERM' hAV
DATE 1612 VALUATION 3t. 1328M LOT TRACT
JOB ADDRESS lS : V1141
APN ..
OWNER
CONTRACTOR/DESIGNER / EN (NEER
78.390 VIA G/.��si.�z';1.2v4TSu _
LA QMWA CA. frt,=
�) G' 1VO,
USE OF PERMIT
41b 1�£i1 t��t'17 �,'•� �f
IOU s.tr. • °!i -L-90 t_ td .&, •h r: ei �J , rwec r'- v.ry a..0
ti' QAfi090 W.€JAt CITY OTANDARD
LF
PO1RCE.iPRA.TM 160,00 SF
DIED CanCr�i" t�'f?�'�'h'�t�i���:.�(
:��.Y7,8:.�'t?
'y `t��� AyrVIM
�3 rt��c uy �v �,v' 91
PLAN PEZ
101S.- 000�JS�Q.a+41
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ry0[�0.411
to rre,0 101W.07KY VICE21D d�_?Yut9Ue�•` 41^U0� g,�0
.
a [1'F-TM,'.AT1��?yyJM��99.�'R,
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tJil'lJ. 4Ji:
ly"aw- Now
[RECEIPT
DATE )N
I BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain -
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
_
r.
/,
RAFTER SIZE AND SPACING
---- =N 'D G t 6
ROOF PITCH
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING NOTE ON REVERSE)
�1� 2 Lei �l•
NOTE:
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' x 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY 05 -PTS
APPROVED
FOR CONSTRUCTION
DATaa sY �T 6eo
to
wL,.T�
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 III
CONCRETE
II I I
II I I
II III II II
ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNERS NAME
STREET ADDRESS
CITY, ST ZIP
TELEPHONE
H.O.A. APPROVAL
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZE
T' AND •L' STRAPS
WITH I
z
I (4) 16d NAILS OR BOLT•
V
RAFTER SPAN: O
�
1 11 I
>
POST SPACING:
f 1�
o
O.M.
OVERALL LENGTH:
a
)
OVERALL LENGTH;__ll
Z
v
3a POST SIZE: -.��__
m
REAR SETBACK
SIDE SETBACK (4'x4' MIN.)
/
I
2000 P.S.I CONCRETE —+1
'FINISH GRADE
FINIS". GRADE
L— II"'-- MIN. 12' x 12- FOOTING I I
L_ J
I
1 Z' BELOW GRADE L _ J
NOTE:
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' x 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY 05 -PTS
APPROVED
FOR CONSTRUCTION
DATaa sY �T 6eo
to
wL,.T�
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 III
CONCRETE
II I I
II I I
II III II II
ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNERS NAME
STREET ADDRESS
CITY, ST ZIP
TELEPHONE
H.O.A. APPROVAL
t "
QQ Q
v v �
RAFTER SPAN TABLE"
coC7 c co,�LL' CONSTRUCTION SHALL CONFORM
GRAPDI2 R70ES �5�, �'T �T a TO THE PROVISIONS OF THE:.
(FEET & INCHES) OJ�� OJ�C'7 OJtiC-7 Q
,Zoo/ CALIFQRi I� BUILDING CODE.
' "'•'� ��� ��� _�~ COQ SUPPLEMENTAL 'NOTES:
2x4
hQ O.C.
2414i'. "
10'-6"
1 9'-6"
1 7'-3"
8'-9"
8'-6" '8'-0" 6'-0"
T-3'
DOUGLAS FIR NO. 1
SIZE
2x6
17,.6' tO:C.
24"
32" "
15'-0"
14'-0"
10'-97'
2 T-0"
12'-6" 11'-6" 8'-9"
10'-6"
10'-0" 8'-6" 1 N/A
N/A
6'-0"
4x8
2x8
16" O.C.
24"
32"
18'-0"
17'-0"
13'-6" 16'-0"
15'-6" 14'-6" 11'-0" 113'-0"
13'-0" 11'-6" N/A N/A
402 2
NOTES:
1. 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED TO 10'-0" USING
THIS STANDARD.
LATTICE
ROOF
BUILT-UP ROOF
HEADERS
HEADERS
DOUGLAS
FIR NO. 1
DOUGLAS FIR NO. 1
SIZE
SPAN
SIZE
SPAN
4x.4
5'-0"
4x4.
4'-0"
4x6
8'-0"
4x6
6'-0"
4x8
1 1 '-0"
4x8
8'-0"
4x10
14'-0"
400
10'-0"
402 2
17'-0"
402
12'-0"
6x8
14'-0"
6x8
1 ?'-0"
600
17'-0"
6x 10
14'-0"
J ."
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
PATIO COVER ELEVATION -
F / b EXISTING PATIOVcR J NEW PATIO COVER
---
/
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/� � � r >mY�:$. - p,.�t gu � �..'t r'J,*k+ 'iXL ^r'1• - .e /
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04-
M
/,
x�•` �;'rt:.. 7�.' : E �L.,.s'�' . ei`�.n • , ..> i''ii,' s�$Y'• � d B', , .., . _ �"..... W� ... k s. °`..$�'f .. � _ JRr � '^§ �:. _— _ � - ii - .1 L{_ - i3 - _ 1" - •�} / J
�.,4". � A'"A ro u✓`/ x 's.�-`�•.. � { r,.. .fir_ —lt— sY � �, �.
4:�.� .. �. K.".fti«,;yf ' d :* ' '��,;��. .- .r f'� ra i.:r' s • A °"� '�" �, '�, V,'� a�.£ , a., c.�[�R'+4 y .a vA F � � '+ �, J j // /
1'T' AND't' STRAPS /
�/COMBINATION f ' J / � .�'b•'I / 6X6X.1/8' WITH
,NEW CUSTOM // / / / / i' J J OPENIATTIUANDJ /BotTs
CABINETS / / / ,% / / ' // / ./ / / J / PMOOD
, % // / / / / % i
/SHEATHING C/W
/MEMBRANETO y j /
MATCH EXISTING / � 4A-6POST'Sl 0
MIN. 12'X12' 2000PSi
CONC. FOOTING
12'-5° 12' BELOW GRADE
CITY OF LA QUINTA
BUILDING & SAFETY DEFT,
APPROVED7
FOR CONSTRUCTION
DATE BY "'7
CONCRETE BIOCK
WAIL WITH 12X12
TIRED SEAL AND FACE
k,
GARAGE .
EXISTING
CONCRETE
WALK
.,. •.......
... ..... EXISTING..
A/c uMr
HOUSE . .
POOL
..�
I
LINE OF
EXISTING J
PATIO COVER I I EXISTING I' EXISTING'" "
I CONCRETE, :CONCRETE
PAD PAD EXISTING
LINE OF J I I. LAWN.;.;e:::,
OVERHANG ( 1i
— — — — — — — — — — EXISTING
FLOWER BED
EXISTING / / // // EXISTING
/ // / CONCRETE
CONCRETE PAD
PAD it7�'
/MIEXISTING.
/ // EXISTING SWIMNG///// /// // // CONCRETE
POOL AND HOT TUB /� ///� /� PAD
CONCRETE..
PAD
/
t EXISTING
v `�`.'i.!.ii!'.:•:::;%P<<..�i, 1..... EDFI
FLOWER B
'r.i,iI, •�.:� :•.ii;'rr . r < �.
EXISTING
:::y :...,;�>::-,...::_,, �,;::=..rr:: .�......-•,:._..:� .,.,....;._...•.. -;::t y�==�:-
FLOWER BED
__ - ya''. �%iii-;:.`.i __ %l= --'r--•. . � r: C. ,��:
EXISTING t "
CONCRETE "•,<'
BLOCK WAIL EXISTING
LAWN .
EXISTING
S I T E PLAN
A A I CONCRETE
IL— IFS LH I \VI SHOWING EXISTING LANDSCAPING AND STRUCTURE BLOCK WALL
FLASHING
CONTINUOUS 2X8 3/4" PLYWOOD C/W
LEDGER SCREWED TO WATER PROOF MEMBRANE
STUDS WITH 3/8" X 5" TO MATCH EXISTING
LAG SCREWS @ 16".O.C.
2X8 RAFTERS
12 2X8 BLOCKING
2X2 LATTICE
II _
NAIL RAFTER TO I
SOLID BLOCKING i``. 4X10 DOUGLAS FIR
HEADER #1
±1 0-011 1 1-(j;� (TO MATCH EXISTING)
4X6 POST TO MATCH
EXISTING
PROVIDE I" CLEARANCE
U-- STRAP BETWEEN POST AND
BOLTED TO 'CONCRETE
COLUMN
M
MIN. 12"X12" 2000 -
PSI CONC. FOOTING 12" BELOW, BELOW GRADE
ANCHOR BOLT
( 7" MIN. INTO
1 n i CONC)
10-411;-
r
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.
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 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 z,an employer and you are subject
ti T to several obligations including State and Federal income tax withholding, federal social security taxes, worker's _
compensation insurance, disability insurance c i -t 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.
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 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 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 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 QUI TA
DEPT. OF BUILD NG D AFETY
78-495 Calle T . p o
La Quinta, CA 9 2
(760) 777-7012
FAX: (760) 777- 1 4
OWNER'S SIGNRE/DATE
78- 390 V,�a
PROPERTY ADDRESS
PERMIT NUMBER(s)