9802-041 (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.
-1Pro6sslonals 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:
'') 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.c�for this re son .�
r Y
safe ,Ad f (:t�/' 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 section need not be completed if the permit valuation is for $100.00 or less).
(.. )el 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 shallfforthwith comply with those provisions..
lDate:J ff+? Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up fo $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 he 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 i
whose request and for whose benefit.work is performed under or pursuant to
any permit issued as a result of this applicator 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 permitn`''to cancellatio
I certify that I have read this application and state that the above informatio s
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.
innaturt- (Owner/Anantl 0! f Date / ,
V SF.
PERMIT# CONTROL#:
B_ UILDING PERMIT _
DATES VALUATION LOT TRACT
21I N98 $4.468.80
JOB SITE
ADDRESS
79-'2& VIC. MA DRIA41,
APN 5
1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DANT FOWIXR..
e-AVNEWB(ALDER
LA QUINTA. CA 922-53
CBL,#
USE OF PERMIT
AT9C )
[21 OPEN LAI710E PATIO COVEi2S IT X W& IT xIT [336
SQ, T.)
PORCINPA;"HO 330.0 SP
GSTINIXfr.ED COST O.F (MMS IR-II(CTION
4,468.80
PERMIT ESE SiYMN ARY
P1. AN C FiRCK FRE 101-000-439.3 W $4r.80
N°rl�iti`► t 4i "f liatd ! EI 101 -OW -418-000 V2.00
`�"'i';i7.bi' a rvfo'1'.t0N FE -f.7, - RE S D 101-000-241.000
.: .�,Q-TOI'AfCONSTRUCTION.ANDPLANCI-WCK
:$1:1930 ,
O rSS PRE -PAID FEES
4�0,.�ti;►'
� AL PETtI lff FJEWSt UD* NOW
$119.30
.
RECEIPT
DATE RBY
DATE FINALED
INSPECTOR
..
..
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
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
BLOCKWALL APPROVALS
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
Neater 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:
4 - RAFTER SIZE AND SPACING SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
' - �/'
/•/}� !N iL,x• 2- 2 (SEE ROOFING ,NOTE ON REVERSE).
6 _fir /�
ROOF PITCH •
it P
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)`
HEADER' SIZE
T AND L ;STRAPS
6"x67xt x1/8". WITH
(4)' 1.6d,NAILSOR ,BOLT
RAFTER
>
SPAN: _1
1
POST SPACING':-----
O.H.
x + w
O.H.
OVERALL LENGTH: 0
a
a
OVERALL LENGTH:'___ �+
POST SIZE:
REAR SETBACK
SIDE SETBACK
' 4x4" MIN.
( )
2000 P:S.I CONCRETE ;FINISH GRADE
FINISH GRADE I -t MIN. 1.2"x12" FOOTING I I.
L—J
I
L=J A2' BELOW GRADE L_J.
•
PROVIDE- k.. CLEARANCE
BETWEEN :POST AND.
' 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 .
"
,3/8" x 5" LAG SCREWS INTO STUDS AT 16' D.C.
• t
NON—CORROSIVE PLATE
GRPp
�
' CONTINUOUS LEDGER ^i
'
ONO
I
4 i6d' NAILS
`
OR BOLT
r
:
U7 -STRAP OR "ANGLE
•
(4)—.,l 6d NAILS
'
OR BOLT.
JOIST HANGER OR •SOLID BLOCKING
`
NAIL RAFTER TO BLOCKING
PROVIDE 1".'CLEARANCE
BETWEEN ANDCONCR
•
' II
w, ,
y III
III
III II
Q'ITY-OFIM CUINTA
_..
.
'.
ANCHOR ,BOLT ' (EMBED
BUILDING SAFETY DEPARTMENT -.J
I
"7" MIN...: INTO CONCRETE)
CONDITIONALLY
.. -
TYPICAL PATLO "'COVER.
ACCEPTED FOP "CONSTRUCTION'
DATE OF APPLICATION'
. a / 3 g
SUBJECT TO INSTALLATION AS PER
OWNER'S NAME
a 4:
e7t
STREET ADDRESS
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CITY; S7 ZIP
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' AND ALL APPLICABLE CODES
..TELEPHONEo
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APPROVAL
•
OF 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 '
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 Bu 1 Ider." 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 oth&,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.busin'ess license '
from the Ciiy. or. County. They are also'required by law to pur,their license number on all'permits for which they.
apply.
If you plan to do your own work,' with the exceptiotrof variuus trades that you plan to subcontract,, you should be. <
aware of.the following information for your benefii:and protection:
If you employ or otherwise engage any persons 'other than your immediate family., and the work'(including materials
and other costs) is 6200.00 or more for the`entire project, and such, persons -are not licensed as contractors or
subcontractors, then you may be an employer. V
If you are' an employer, you must register with.th'e-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 carry1. our 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 Divisionof Industrial Accidents..
If the structure is intended for sale, property owners who -are not licensed cont racto'rs,are allowed to perform their
work personally or through their own employees, withouta iiceiised.contractor or subcontractor, onlyunder 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 unfit the verification is returned --:
Very truly yours,
CITY OF LA QUINTA
DEPT: OF'BUILDING AND SAFETY
78-495 Calle Tampico
La Quinti, CA 92253;
(760) 777-7012 .
FAX: (760) 777-7011
CEO,. "
OWNER'S SIGNATURE I DATE ,
PROPERTY ADDRESS
PERMIT NUMBER(s)