9910-218 (PAT)LICENSED CONTRACTOR DECLARATION
CO i hereby affirm under penalty of perjury that -1 am licensed under provisions of
H Q apter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 C*W Professionals Code, and my License is in full force and effect.
CD ch License # Lic. Class Exp. Date
LU
cZ ti Date Signature of Contractor
(D O. rr
J U OWNER -BUILDER DECLARATION,
UJLU I hereby affirm under penalty of perjury that I am exemptfrom the Contractor's
U) License Law for the following reason:
Z ( ) 1, 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).
Cr)
(,) I am exempt under Section , B&P.C. for this reason
O N Date `-' 7 ?)Signature of Owner
d Z WORKER'S COMPENSATION DECLARATION ✓
o Er I hereby affirm under penalty of perjury one of the following declarations:
r H O O 1 have and will maintain a certificate of consent to self insure for workers'
X uj - compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q I have and will maintain workers'compensation insurance, as required by
O V. Q Section 3700 of the Labor Code, for the performance of the work for which this
a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cba
g (This section need not be completed 0 the permit valuation is for $100.00 or less).
`( I certify that in the performance of the work for which this permitis issued,
shall not employ any person in any manner so as to become subject 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, 1 shall forthwith comply with those proyisions.
,,,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 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 inspection purposes:
;Signature (Owner/Agent) a Date 1`'>
L_e
PERMIT #
BUILDING PERMITAdd�:� - �-
DATE 1����'7�t "VALUATION S4,876 10 LOT , TRACT
JOB SITE
ADDRESS 4i -17S DUNNE PetLM, 3 .HQ1rAD
APN �g(y-f43ii A3.i �
OWNER
CONTRACTOR/.DESIGNER ENGINE. ER
moi A9 J f -
I P, �a F
(_1%VXi Ail{LEr
LA (jUlNvv Cry. 0251
11
USE OF PERMIT
.,
k'/�a;("f �((>A � 10 517.Eisi aF
PLAN CHECK. it 553,50
00`4; TRT ra::'t'i,` N FF 14 aut ittu6-41?t•(t(N.1 �sG on
TR ^,t`.N H'.RESA'. 1' 14 tltlf) a..,.
,;i
' (YI'fAL PE>f+ls'9t'll' ➢PR E S DUVINOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.a
INSPECTION REC��i�,'
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BV.D9LD�NG
APPROVALS
MECHA=AL 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
I l 4*
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
(POOLS o SPAS
BL®CIXWALL
L APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P[bg. Test
Final
Gas Piping
PLUMMNG 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
COMMENTS:
Final
Utility Notice (Gas)
fELECTRCALF, 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 — aQ
Utility Notice (Perm)
Poor PTTCM 4
VLI
CONI NUOUS LEDGEF
(SwE SIZE AS RAFTERS) i
HEADER Si'E
11 X12
'T' AND 'L' STRAPS
6'3,6'xl'Yt/r WITH
(4) 164 NA,LS DR BOLT
• f j f 1. 'r �!r � !I 1 I�
RAFTER SPAN': �,j! _I� _-- ' y_ Q' POST SPACING: 2 !r. O
1 !!, oIr
_Z.
OVERALL LENGTH, (2 0 a OVERAtL.LENGTH:
�,I• � rr
lijPOST SIZE;.
io
REAR SETBACK SIDE SETBACK
1
1
FINISH GRADE FINISH GRADE MIN. 12'x12 FOOTING
2000 P.S.I CONCRETE —� I I V,-, 1 1
L_J L_J 12 BELOW GRADE L
PROVIDE .,1` CLEARANCE
EIWEEN�-?OST SAND .
CONCRETE
-
OPEN LATTICE PATIO COVERS MAY BE ATTACHED.;TO EXISTING FASCIA
MA ONE 11,C x S' LAG SCREW THPOUGH: fASCN INTO EACH RAFTER TAIL.
= U -STRAP WANGLE
LAL SCREWS INTO STUDS" AT IT O.C; NON -CORROSIVE, PLATE ApE
CONTINUOUS LEDGER
(4)- 16d NAILS
OR BOLT
U—STRAP OR ANGLE
(4.)— 16d NAILS
/
OR'BOL•T
JD;ST HANGER OR SOLID S�DCKING
NL.IL r<arTER To BLOCKING
PROVIDE 1. CI EARANCE
BE POST'AND
CONCRETE
ILII ! Ill
ANCHOR BOLT (EMBED
7 MIN. INTO CONCRETE).
BUILDING DEPARTMENT APPROVAL BELOW
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
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TYPICAL PATIO COVER
FOR CONSTRUCTION
DATE OF APPLICATION
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OWNER'S NAME
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DATE D BY&_=z
STREET ADDRESS
Com• ST ZIP -
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TELEPHONE
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H.O.A. APPROVAL
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CITY ,Q:FLA.QUIfqTA
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UILDING & SAFETY DEPT.
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FOR CONSTRUCTION
DATE
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OWNER/BUILDER INFORMATION
Dear Property OiMerc ;�
An application for a building -permit has been submitted in your name listing yourself as -the builderofthe 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 Land 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 employerand you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disabilityinsurance.costs,and unemployment compensation contributions.
There may be ftnancial 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 specificinformation 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^Calle Tampico
La Quinta, CCA 92253
(760)777-70.12
FAX: (760) 777-7011,.
to -z 7 -9y
OWIR'�S SIGNA RE/DATE
Z)"Vo_�t__ PAN 120 14 1
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