9710-007 (PAT)4
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I LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I 'am licensed under provisions of
Chapter 9 (commei'Aing with Section 7000) of Divisi6rs.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 here affirm under penalty of perjury that I am exempt from the Contractor's
Lice - se 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
O I am exempt under Section ; B&P.C. for this i
Date'' y1 Signature of Owner
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 ection,need not be completed if the permit valuation is for $100.00 or less).
V. 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
rubject to the workers' compensation provisions of Section 3700 of the Labor
Code, f sh II forthwit comply with those pro y�sions' .
Date Applicant
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 Ouinta, 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 thatthe,above information is
correct: I agree to comply with .all City, and State laws relating to the building
c nstruction, and hereby authorize representatives of this City `to enter upon
e above-mentioned property for inspection.purpos •
Signature (Owner/Agent) �� 2 Z , te
BUILDING. PERMIT PERMIT# CONTROL#
�d72 Qf-i#)'7 '
DATE VALUATION S.5.1247.00 LOT TRACT O
1 �347
JOB SITE a�• i{���1L � HAH11,AN DURIIVE,
APN 04-232—Wfi
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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LA. C,0JIN (A CA 4225
Y
OILY
USE OF:PERMIT
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OF LA
'RECEIPT
DATE ',
By
DATE FINALED
INSPECTOR
C!�nI 5'E .Tt��E
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Sit Backs
Forms & Footings
Slab Grade
eel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wail Insulation
Party Wall Firewall
Exterior Lath
nnrwall _ Int 1 afh
BLOCKWALLIAP'PROVALS
Set Back
Final
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Condensate Lines
Stee6=
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
PLUMBING APPROVALS Gas Test
Electric Final
Waste, Lines Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans 1 O:K for Finish Plaster
Gas Test
COMMENTS:
Final
Utility. Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
.'Flnsl
UUIHy Notice (Perm)
POOLS - SPAS
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 performedby 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 yourbenefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and othei costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or,
subcontractors, then you,may boan 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 insurancecostsand unemployment compensation contributions.
There may be financial,risks for you if -you do not carryout 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 obligationsunder 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 maybe 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 Calle Tampico
La Quina; CA 92253
(760) 777-7012
FAx )�:z7-7o1,1
ca
OWNER'S SIGNATUREIDA-TE
78 -70s LJ. �pi?=LAot) 'De -
PROPERTY ADDRESS
.q710 - QO
PERMIT NUMBER(s)
L 'i
RAFTER SIZE AND SPACING.
– – – – — – – – – -
ROOF PITCH
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZE
RAFTER SPAN:
RALL LENGTH:
uj
O.H.
uj
Go
0
x
am
SPECIFY' Rb()F:NG AND SH -LATHING '-',R OPEN LATTICE
(SEE ROGFING NOTE ON REVERSE)
— -------------------
'T' AND V STRAPS
6"x6rx1"x:I/8" WITH
(4) 16d, NAILS OR BOLT
I POST SIZE: -------_- I In
REAR
-------
REAR SETBACK SIDE SETBACK (4_x4" MIN.)
.S.1 'CONCRETE
2000 P I u FINISH GRADE FINISH GRADE
I --MIN. IZ*klZ' FOOTING
L— J L 12* BELOW GRADE
PROVIDE I CLEARANCE'
BETWEEN POST AND
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,
=.3/9' x S' LAG SCREWS INTO STUDS AT 16' O:C.-7
NAIL RAFTER. TO - BLOCKING
BUILQJ�- , _-,I-AmmRQ IYEMW V
U -STRAP OR AN(
NON -CORROSIVE
(4)- 16d NAILS
OR SOLT
U -STRAP OR ANGLE
(4)- 161d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
.BETWEEN, POST AND
ANCHOR BOLT (EMBED
7 MIN. INTO CONCRETE)
TYPICAL PATIO -COVER
It APPLICATION
OWNER NAME.
AREET DDRESS
�, STT ZIP lt—
TELEPHONE
H:O.X APPROVAL,
RAFTER SPAN TABLE
GRADING RULES ALL CONSTRUCTION 'SHALL CONFORM
PS 20-70 TO THE PROVISIONS OF THE 1.9,94
6
(FEET & INCHES) A�UNIFORM BUILDING CODE.
o' 4� I'v
O SUPPLEMENTAL, -NOTES.
2x,4
1:6" O.C.
N!'
1:0'-6"
9'-6'
T-3"8'-T�
DOUGLAS
8'-67 8'-0,' 6'-0'
7'-37
SIZE
SPAN
2 x 6
1'6" 0.c. ' '
24
52"
5'-0"
14'-0"
10" -gr:
13'-0"
112'-6" ' 11'=6" 8--9r
10'-6"
TWI. 8'.6" N/A
N/A
4x10
14'-0"
W
16" O.C.
24'
3Z
-0"
17'-0"
-13'-6"
1'6'-0"
."IV
115!-6" 14'4` 11'-0"
13'-0",
13'-0" 1 V-6" N/A
N/A
NOTE
Z O.C. SPANS ARE ALLOWABLE FOR OPEN LATTICE
PATIO COVERS ONLY..
LATTICE
ROOF-
BUILT-UP ROOF
HEADERS
HEADERS.
DOUGLAS
FIR NO,, I
DOUGLAS' FIR NO. 1
SIZE
SPAN
SIZE SPAN
4k.4
5'-0"
4x4 4'-0�'
4x6
8'-0"
.4x6 6'-V'
,4x8
11°-.0"
4k8
4x10
14'-0"
4x10 1101-0.
4x 1 Z
17'-0"
4x12 1.2'-0'
14'-U'
6x8 1'2'-0"
6x10
17'-0
6x10 14'-07
ROOFING NOTES:
A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN.
B. ROC . K I ROOF: 3/12 MAXIMUM PITCH.
2X2- LA, -r -r I C -E
Ga 6"
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NEADER-
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76-765
CA Z253
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