0203-151 (PAT)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:
(;�4) 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 exclu�ely_contractidg)with licensed
contractors to construct the)xoject (Sec/7044, Business &-Professionals
Code). �
'r T
O I,.am exempt under Sectior� ,B&P.C. for this teason
Date !Z .,�_ Sign re of Own11 �`�z 41 Z
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltVf perjury one of the followiry declarations:
() I have and will maintain Acertificate of consent to self -in e for workers'
compensation, as provided fVby Section 3700 of the Labq Code, for the
performance of the work for wh ch this permit is issued. f
( ) 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 r 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 §Rall not employ any personZinany manner so as to become subject to the
workers' compensation laws of California, and agree that if I s ould,become
subject to the workers' compensation,provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisl s.
f
Date. ..P . c 27 Applicant � •r -
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 this City to enter upon
the above-mentionedpropertyfor inspection purposes.
,.Signature (Owner/Agerit)"-r✓ !�� Date 2 ii 4 ,
t
BUILDING PERMIT PERMIT#
DATE VACUA?ION" ,,�•�•.,, . LOT 51 4203 TRACT
: - . �;!s 5. ) 140 23369
JOB SITE
ADDRESS
78-'M LA PAUM DR
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TrAWI fY TWASSR,
OWNfT:,�i.cif M DER
LA QtINTA CA 92253
USE OF PERMIT
PATIO
�fi��:iY1M',tl0Nff£ZRMFUS.S.MP�.�' 3997yilvt3VOM.A1JM3NIs'l�a['�3�
CODE 0:404.5 FORWORK HAMM WITHOUT f)1Jjit,DWO rPi"lNIT,
£'ORMPA TIO 426,0E SF
�'693,1{.db%Fd'd Rd.`s.its' CWON or, 4.1 N16!b:�'4•UCTIk.7b7
��ggyy,�++��yy,,/����++yy ��� �y �Tn�
AARY
PLAN CHECK FEE 101.OW— 439"318 W10
S
i1tiIS"l �t�oN l`i6 1d Frz 101-00,0-418-000 $Rl z
O 'fb�O i ibXar��Nt� -1�t 1C99QOQO2. + �Jt) 196
ANWESTI(WfIt`NF99— l``�i �ii�tlC) tai? $83.0
M �
A c1 4 2902
CITY113FiLAQW47A
'd 9. PRL. PAM 174
S S0.0I9
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.. / 4j l i.A •�
/{'Wyk
4
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
Z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Unes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
-/1/ 6-17-
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Prumbing Top Out
Equipment Enclosure
ower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping ,
Gas Test
Appliances
Final
COMMENTS:
a
A
-
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)
. TELEPHONE (760) 777-7012 FAX (760) 777-7011
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 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.
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 QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 C Tampico
Uinta, CA 2253
(760)777_7 2
FAX: (76 777- 11
.14-o2__
OWNER'S SIGNATURE/DATE
I &L-� to LiAl l L� _D v
PROPERTY ADDRESS
02G�^ 151
PERMIT NUMBER(s)
RAFTER SIZE AND SPACING
2X G- - ---
—9f -A1--------
R00r PITCH
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZE —/
_ �j K 2_q
SPECIFY ROOFING AND SHEATHING OR ODEN LATTICE —
(SEE ROOFING NOTE ON REVERSE;
RL-'' RfGt
'T' AND 'L' STRADS '
6'x6'.1"x1/4" WITH
PROVIDE 1" CLEARANCE
NOTEBETWEEN POST AND
: CONCRETE
VIAEONE LATTICEEN /4" x 5o LAG SCREW THROUGH COVERS MAY BE FASCIA OINTO EXISTING
EACH RAFTER TAIL.
T3/8 x 5' LAG SCREWS INTO STUDS AT 16" O.0
/ / CONTINUOUS LEDGED /
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCT1 N
DATE ► E2 BY
cis) G G G�` y
U -STRAP OR ANI
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)
-Rj
W
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS[lJ 7fD
clrr. sr ZIP
(� / G 1. Z LSA
TELEPHONE
H.O.A. APPROVAL
^~ ''` SPAN '~BLE /1 L CONSTRUCTION SHALL C{}NF{}Rk1
GRADING RULES
TO THE PR[lV/��ON�� [l� TA�^
PROVISIONS - -' THE:
'^ ^
1998 CALIFORNIA BUILDING CODE.
-V
SUPPLEMENTAL NOTES.
NOTES:
l 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, I
DOUGLAS FIR NO. I
i SIZE
SPAN
SIZE
SPAN
10
ROOFING NOTES:
A. BUILT-UP. ROLLED ROOF: 3LDp[ TO DRAIN.
B. ROCK ROOF: 3/12 MAXIMUM PITCH. ^