0011-094 (PAT)LICENSED CONTRACTOR DECLARATION
„I hersby 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
Professional: 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 -1, 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 contracting with licensed
contractors .to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am xempt under Section B&P.C. for this reason
Date Itii j,"^ Signature of Owner
jilt
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.
( ) 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
Code, I shall forthwith comply wit pose pro kions.
Date: a s � ,_ :Applicant tr,,s: F '4 .:kr4l,.
Warning: Gall4re 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. I .
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 insp cfio purposes.
Signature (Owner/Agent)( r Date 7 °��•
BUILDING PERMIT PERMIT t/
DATE VALUATION LOT ci1 TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
A!4/14,MCE,
�lsT.3J v
79.141 KAY'?, COURT
L A (pUOi M CA 92753
CTWX
USE OF PERMIT
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394 S. F. L ArI''t ICZ PATIO 4::OVIK'f2 AS PPR A.W'PROSVS6 CITY S'TA'm).ft,R11
PORM—TiPA'IIO 594,00 SP
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7,910.20
PLAN (113MIM "':. 101-000.439.318 664,204
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1D 101-000-241-000 S,79
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SUB 40TAL,t",ONt3'3:RUt`g09ANTTx�t�+V%,si�►^t.Y�rC31IN'.,>nNK
$164.14
' FEEN DUYNOW
"$1641
u
RECEIPT
DATE
BtY` ` �� DAT�FI ED
INSPECTOR
• tw.. i,,
INSPECTION•RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
+ BUILDING
+ Set Backs
APPROVALS
r_�0 j 75
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Slab Grade
(
Ducts
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 6_
BLOCKWAL.. �iPPROVALS
Final
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:
SPECIFY RO, A SHEATHING OR OPEN LATTICE
RAFTER SIZE lJoll,
-.•F OTE ON
1 U WIT (S
� I
ROOF PITT
=a�lW-
/
`- CONTINUOUS LEDGER
PIZE AS RAFTERS)Vc
�(�AgE
H VER SI
'T' AND •L' STRAPS
6"x6'x1"xi/8•' WITH
I w
—_
Z ,
I (4) 16d NAILS OR BOLT
L
RAFTER SPAN:
POST SPACING:_ _____
Ll
0. H. w O.H.
v
OVERALL LENGTH: I
0
a.
a
, '
OVERALL LENGTH:_. " i
Z
i
_ :____
____
u ll
ro
�___-_
POST SIZE:'_
- __�__,_
REAR SETBACK SIDE SETBACK
(4"x4" MIN.
/
I
FINISH GRADE FINISH GRADE
2000 P.S.I CONCRETE MIN. 12"x12" FOOTINGI I
L_J L--� 12" BELOW GRADE L_J
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
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 OUINTA
BUILDING. SAFETY DEPT.
APPROVED
FOR CONSTRUCTI(O
DATE /r�vo eY
1?
c a . 6U 66
U -STRAP OR AN(
NON -CORROSIVE
(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
I
CITY, ST ZIP
TELEPHONE -n L r. -1-1 1) Dur)
H.O.A. APPROVAL
RAFTER SPAN TABLE �� A�7
GRADING RULES
PS 20-70 Cv O Ov ' F�
(FEET & INCHES) 0 00��'' OQ
'v 'dam "v
NOTES:
1. 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. R SOLID TIO COVERS (NOT LATTICE)
RAFTER SPA S LIMITED TO 10'-0" USING
THIS STANDAR
LATTICE ROOF BUILT-UP ROOF
HEADERS HEADERS
DOUGLAS FIR NO. 1 LUGLAS FIR NO. 1
SIZE SPAN I SIZE SPAN
4x4
5'-0"
x4
4'-0"
4x6
8'-0" -
4x6
6'-0"
4x8
11'-0"
4x8
O.C.
®1
14'-0"
1 •
®1
�� : •
1
4x 12
12'-0"
6x8
'
6x8
®®®
6x10
17'- '
•
14'-0"
NOTES:
1. 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. R SOLID TIO COVERS (NOT LATTICE)
RAFTER SPA S LIMITED TO 10'-0" USING
THIS STANDAR
LATTICE ROOF BUILT-UP ROOF
HEADERS HEADERS
DOUGLAS FIR NO. 1 LUGLAS FIR NO. 1
SIZE SPAN I SIZE SPAN
4x4
5'-0"
x4
4'-0"
4x6
8'-0" -
4x6
6'-0"
4x8
11'-0"
4x8
8'-0"
4x10
14'-0"
400
10'-0"
4x 12
17'-0"
4x 12
12'-0"
6x8
14'-0"
6x8
12'-0"
6x10
17'- '
600
14'-0"
ALL CONSTRUCTION SHALL CONFORM
TO THE PROVISIONS OF THE
1998 CALIFORNIA BUILDING CODE.
SUPPLEMENTAL NOTES`:
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH.
GNOMON mp
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 tie 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 fo.r the proper permit' to his or her name.
Contractors are required by law Bio 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. i
u �
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 ai nd protection:
I
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 bean employer.
If you are an employer, you must register with the Siate 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.
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.
i
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 th.Lt 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. f
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, Califon is 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 QUINTA j
DEPT. OF BUILDING AND SAFET^'C
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
F (760) 7 7Vd
llh,.4110
OWNER'S SIGNATURE/DATE , I
I
is
PROPERTY ADDRESS
PERMIT NUMBER(s)