9703-054 (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 perjurythat 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
cwr9Ctbrs td construct the project .(Sec. 7044, Business & Professionals
Code). -�
O I am exempt under Section B&P.C. for,this reason '
Date r— i""1 Signature of Owner
WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations:
f({); 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).
() 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
subject to the workers' compensation provisions of Section. 3700 of the Labor
Code, I shall forthwith comply with those provisions. Ate•
Date: �' '7
Applicant +'
J'
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 • f
the
e above-mentioned property for inspection purposes.
Signature (Owner/Agent) r Date x�- r + •t,
PERMIT# CONTROL#
BUILDING PERMIT
:,�,� 4 1�
DATE 3`17x9,7 _VALUATION S2,7111.20LOT • .. .TRACT
JOB SITEg �p •y�
ADDRESS 1".65 VA.�,i9.r .4A 9. RIVE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
11AVAPIS ACNE.S JOVE
G%1 PIE
r.,a. c;X12.t.NrA. CA 922,53
USE OF PERMIT
BUILDING
1 V h 01 CATg4 LKril,`lt; E 1>A310 CCaV!3a
PORCILT S,,i1.1.1.10 ! . 204. t Sr
fif..AN C111c'.Ib.FU 10t-000-419-318 $ iS, 1.0
+;QRMNV.P:TII()N I I FTr� 54,t1f)
sn-c e ita £414 r tt�7id I� l� i21. 5l%) j:cj i.<.�; f_��r,r" 1itj ,fit
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RECEIPT
DATE..
BY
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
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
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)
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)
>t
RAFTER SIZE AND SPACING
ROOF PfTCN
COHTINUOUs Li m
HEADER SIZE
ZL
RAFTER SPAN:
O.H.
OVERALL LENGTH:
REAR SETBACK ,
2000 PSJ CONCRETE RNLSH GRADE
I
SPECIFY ROOFING AND 9EATHNc OR OPEN LATt10E
(SEE ROOFING NOTE ON REVERSE)
'*—t AND 'L• STRAPS I
(1Kt64 w xt//t m
I NAES OR 9OLT I
POST SPACW.
o.N.
OVER&L LEII Ift. '
i
YIN• 4•xS POSTS m
MACK
YIN. Wor Fomm
Ir snow GRADE LJ
nova I' Cv.AA LICE
80%M POST IMO
AM.
OPEN LATTICE PATIO COVERS MAY 9E ATTACHED TO EXISTNIG FASCIA t�gRAP OR An
VIA ONE t /S x S LAG SCREWTFNIOIJGN FASCIA tNTo EACH RAFTER TML.
NON-COMOSIVE
3/fC x S LAC SCREWS Nilo STUN AT 1 S O.0r- COHT1Nu0US LEDGER .
T
e w
BUILDING Ctt SAFEW DEPARTMENT
0,11JIFTANNESEX-1 Us'
•
81E 90LTd W"
N -STRAP OR ANY
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(� T mu
901T
ANCHOR BOLT/yQ�
T YIN. Wm OO ._._._1
IE 1' CLEARAIICE
R...�JI POST AIID
CONCRETE
TYPICAL PATIO COVER
OF APPLICATION
ER'S WIIE
MT ADDRESS
• ST ZIP
N.OA. APPRDVYIL SIOHIATiAIL Omm