0105-120 (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. I
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 contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(}/lam exempt under Section B&P.C. for i, reaso�t
D e:. r.� Signature of Owri _ �7
F
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).
( A certify that in the performance of the work for which this permit is issued,
I all 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 provision. f Se�ctioh,6700 of the Labor
Code; I shall forthwith compjy„yvitlj those pr
ovisi n ---
Date _ Applican [
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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result -of'this appli,tion becomes null and void'if
work is not -commenced within room 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 inspect: on u poses.
eSignature (Owner/Ag A,J, Date � » '•'�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (){t TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
4145^895 WMI�l�U EON Mr.
LA QUDTTA CA, 9225.s
USE OF PERMIT
RATIO
C;f3N. TRt;3C T 2 I,Ai:t'TIC; F,,P f IU CiriVMS3 i Y X 1 ' &. $' X 110-,
TOTAL,261 vQ F T. F2.FAt APPROVED MAX A TACIT ED
PORCF1lk'.all 361.01) SF
irOYT OF C.`6J'xRMUir.L O
w'f��8nr.^id
�1fiY9rk.6Ei".W.RRND
A."�i1.18 .PJb3id3i 1�• V1h'�,t'U.IGIS�.&
`(- .
PLAN G'HWIK FEE 101-000.41.39.318 MOM
C'C?.%fS'PRLIGTiOV FE -8 1Q'1�Ca f); ,I11-rIt?tJ X63,40
0.T,11.ONO MOTIM III, -PLESID 103.0010-241-000
`4•
6
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-� M' 1-`r0TALf'016(.�1°St ! !'Y.e Yf:''1 ,�{
$104:45
LESS :tom -TAU) FM
$(),Do
Ir P
M MIN DVE now
S104,45
M AY - 8 2001
R CEIPTU
FIN f B
NCE DEPT.'r�j
(,
DATE FINALED
INSPECTOR
INSPECTION RECORD ,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs S / l -
Forms & Footings
MECHANICAL APPROVALS
Underground Ducts
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 z!_a�
BLOCKWALL AP ROVALS
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 Not (Perm)
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CITY OF LA-QUINTA
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BUILDING & SAFETY DEPT.,
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CITY OF LA-QUINTA
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BUILDING & SAFETY DEPT.,
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FOR C STRUCTION
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RAFTER SIZE AND SPACING
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING TE ON REVERSE)
" ROOF PITCH
Ll
If 11 10 11
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
'
HEADER SIZE
'T' AND 'L' STRAPS
I 6 x6`x1"xl/8" WITH
I W
(4),16d NAILS OR BOLT
RAFTER SPAN _ '
POST SPACING:_
_
O.H.
C..
OVERALL LENGTH:. + a
.
OVERALL LENGTH:______
POST SIZE: 4 x
-- io
REAR'SETBACK SIDE SETBACK (4"x4' MIN.)
FINISH GRADE FINISH GRADE MIN. 12' x 12" FOOTING
2000 P.S.I CONCRETE I . I Imo—
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ZI
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L J I
L i 12" BELOW GRADE
L__J
PROVIDE
1" CLEARANCE
'POST
BETWEEN
AND
NOTE.. - -
•
CONCRETE y
_
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4" x S'`LAG SCREW,THROUGH FASCIA INTO EACH RAFTER TAIL.
L11—STRAP. OR ANGLE'
x 5" LAG SCREWS INTO STUDS;AT. 16' O.C.
NON—CORROSIVE PLATE
RPpE
x
�,3/8"
F
G N
CONTINUOUS LEDGER''
16d NAILS
OR BOLT
'
U-STRAP OR ANGLE``
(4).— 16d ,NAILS'
OR. BOLT
JOIST,HANGER4 OR SOLID BLOCKING
NAIL RAFTER"TO BLOCKING
I
PROVIDE 1" .CLEARANCE
7.
BETWEEN POST AND '
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CONCRETE - • I I I �
II
.� ..III
BUILDING' DEPARTMENT. APPRO.VAL 'BELOW `
II IIS
III II
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ANCHOR BOLT (EMBED ,
-7" MIN.' INTO CONCRETE)
CITY• OF to QUINTA
:.:,TYPICAL-
PATIO
COVERT
BUILDING &9�SAFETY DEPT.
"
DATE OF. APPLICATION
OVD
.
Id e
OWNER'S NAME
* `
STREET ADDRESS' -.
FOR CONSTRUCTI
`
CITY. ST; •. ZIP
!
TE 0/ BY
L
TELEPHONE .'
H.O.A. 'APPROVAL '
'
in
1
RAFTER SIZE AND SPACING
ROOF PITCH
CONTINUOUS LEDGER
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING ON RkVERSE)
aX
• •rr
(SAME SIZE AS RAFTERS) u u u - u u u
HEADER SIZE T' AND 'LSTRAPS
$'x6'xl"x1/8" WITH
W (4) 16d NAILS OR BOLT /
RAFTER SPAN: ------ 1_LlPOST SPACING:__L.L—_
O.H. w O.H.
0 `♦ /�
OVERALL LENGTH: a "OVERALL LENGTH:__-' S
/ ------
_L-__ POST
/ REAR SETBACK I SIDE SETBACK (4'x4' MIN.)
2000 P.S.I CONCRETE FINISH GRADE FINISH GRADE
MIN. 12" x 12" FOOTING I I
L_J L -J 12" BELOW_ GRADE, L
PROVIDE 1;' CLEARANCE
BETWEEN POST AND
NOTE:
CONCRETE
OPEN LATTICE PATIO COVERS 'MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4" x 5" LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
U—STRAP OR ANGLE
f
3/8" x 5" LAG SCREWS INTO .STUDS AT 16" D.C. NON—CORROSIVE PLATE
G
CONTINUOUS LEDGER 04
� 0�
(4)— : 16d NAILS.—/
OR BOLT
U—STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
JOIST HANGER OR SOLID BLOCKING ,
NAIL RAFTER TO BLOCKING
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE '
BUILDING DEPARTMENT APPROVAL BELOW
II �I
II III
ANCHOR BOLT (EMBED
7" . MIN. INTO CONCRETE)
CITY OF LA OUINTA
TYPICAL PATIO COVER
BUILDING &SAFETY DEPT.
DATE OF APPLICATION
.APPROVED
I
OWNER'S NAME
FOR CONSTRUC_ R
STREET ADDRESS
•
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CITY, ST 'ZIP
DATE 401. r?v__
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TELEPHONE
H.O.A. APPROVAL
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OWNER/BUILDER INFORMATION
x
Dear Property Owner: m
• 06
tr �.
,An application for a"building permit hae been submitted in your name.listing yourself as the builder of the property
r '
improvements spec,Gf e&-
Fgr.you protection foutshould be aware that as "Owner/ 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 quired`by law to be licensed and bonded by the State of California and to have a business license
from the City «E'Count� .. They are alsoc�iii d •by law to put their license number,.on`all' perrriif?for'which they'
apply -4
9
If you plan to d"our,own work, with 42yception o akouus trades that you plan to subcontrac , you should be
aware of the following information for your benefit and pr tection,,,
persons immediate family, '
If you employ or otherwise, engage y other than your and the work (inc uding mater?a Vs
>C
and other costs) is $200.00 or more for the entiie project, and such persons ,armee not,, licensed as contractors ore
subcontractors, then you maybe an employer. i
If you are an employer, you must register with the State and Federal Governmentdas 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.
Thei; `maybe financial risks for you if you do not carry out these obligations, and1these risks are especially serious with.
respect to.Worker s compensation insurance :
For more specific information about your obligations undejccleral 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.
.... ; F LA.
Ifhe structureis inte _ded for sale, property�,o ners-who=are not licensed contractors are allowed to perform their
limitedr
work personally or through their own employees, without'! licensed contractoFer subcontractor, only under
\conditions. \ a.,
' "Owner/
• xnl"f A, f eque it, practice of�nlicense&persons profe sing1towt'�e•�c�o�ntractors is to secure an Builder", building
perm its erroneously im" plying that the property ownerNi'roviding his or her own labor and material personally.
,Building permits are not required to be signed by p operty owners unless they are performing their .own work
personally,
Information about licensed contractors may be obtained b` contacting the Contractors' State License Board in out
Y Y g Y
communitypr'at 1020 N. Street, Sacramento' California 95814.
'Please complete and yreturn 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. A
t
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico°
La Quinta, CA 92253 }
(760) 777-7012 . .
FAX: (760) 7,,7,,7--n7011
a.Y�Qy (s2.L� S�- � • O f .. -
OWNER'S SIGNATURE/DATE