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10690 (PAT)Building Address 78-670 villeta 4 P.O. B 7&105 CAL LA QUINTA, CA BC MaThey Mailing Address same. City Zip Tel. La Quinta 92253 364-•1106 Contractor i�'i neX iBuilder Address Zip I Tel.: State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City Zip State - Lic. # LICENSED CONTRACTOR'S DECLARATION' I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city. or county' which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance also - requires the applicant for such permit to file a signed statement that he is licensed pursuant to . the provisions of the Contractor's License Law, Chapter 9 (commencing- with Section 7000). of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit-su; subjects the applicant to a civil penalty of not more than rive hundred dollars.($500):. 0.1, 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, Buisness and c Professions Code: The Contractor's License Law does not apply to an owner -of property who builds or improves thereon and who does such work himself -or_through his own employees, provided ,that' such Improvements are not intended or offered for. sale. If, however, the. building or improvement is sold within one year of completion, the owner -builder will have the burden. of proving that he did not build or improve. for the purpose of sale.) • ❑ I, as owner of the property,.am exclusively contracting with licensed contractors to con. ' struct the project. (Sec. 7044; Business and Professions Code: The Contractor's License Law ' does not apply to an owner of property -who builds or improves. thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - O 1 am exempt under Sec. B. & P.C. for this reason Date OwneriL WORKERS' COMPENSATION DECLARATION ( I hereby affirm that I have 'a certificate of consent to -self-insure, or a certificate of IWorker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ' O Copy is filed with Ihe.city. ❑.Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM / WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. + LDate Owne c _. NOTICE TO APPLICANT.- ff, after making this Certificate of- Exemption you should become subject'to the'Workers"Compensation/provisions of the Labor Code, you 'must forthwith • comply with -such -provisions or-thispennit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) - Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I•agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the -above-. mentioned property for inspection purposes. Signature of applicant Date' Mailing Address City, State, Zip 1504 C N0. 1090 LE ESTADO LIFORNIA 92253 ��� UILDING: TYPE CONST. OCC. GRP. .P. Number egal Description roject Description ..Patio Cover Sq. Ft. X32 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑" Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side.Setback from Property Line FINAL DATE INSPECTOR Issued by: Date � Permit Validated by: Validation: Estimated Valuation 5 659..20 PERMIT . AMOUNT Plan Chk. Dep. Plan Chk. Bal. 52.65 Const. 81.00 Mech. Electrical 24.00 Plumbing S.M.I. .60—_ Grading Driveway Enc. Infrastructure TOTAL 158,25 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side.Setback from Property Line FINAL DATE INSPECTOR Issued by: Date � Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SD. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SQ FT ® TEMP)POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM REMARKS: KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® IVi c SEWAGE DISPOSAL SQ.FT.GAR ®,34c HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND- A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND."Rt_ IM.. �a �%� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP)POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING I r( " if" ') �/nve / /i J'4 Q1,/.,v yI f / L �V((( REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. 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