003520 (BLCK)�i�v n� 1'u,QuiHta
P.O. BOX 1504 No, 003520
Building 78-105 CALLE ESTADO
Address 51-260 Avenida Palma LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 51.260 Gale Palma
City Zip Tel.
La Quin ,a..- 92253. 39808961
Contractor
Owner/builder
Address
" City '
State Lic.
& Classif.. .
Arch.; Engr.,
Designer
Address
Tela
City
Lic. #
Tel.
City in State
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Wood Fence
Sq. Ft.No. No. Dw.
v
Size 215 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
.. . .. ....
Lic. #..
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become
LICENSED CONTRACTOR'S DECLARATION
a,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) Division
of 3 of the Business and Professions Code, and my license is in full force and -
effect. _
Front Setback from Center Line
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 '
peimit 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
Estimated Valuation
�y
'
.PERMIT -
the provisions of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of
Division 3 of the Business acid 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 -
I hereby affirm that there is a construction lending agency for the performance of the
_
Plan Chk. Dep -
subjects the applicant to'e civil penalty oPnot more than five hundred dollars '($500). . ' - . ..
O- I, as owner of the property, or my employees with,wages as their sole compensation, will
-
.Plan Chk. Bal.._
COr1§t.
do the .work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does. not apply to an. owner oPproperty, who
"himself
Mech.
builds or improves -thereon and who does such work of through his' own employees,
provided that such improvements- are not intended or offered for sale. If,: however, the building
' Electrical
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.) .
Plumbing
0 1, 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
S:M.I.
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .,
O I. am exempt under Sec..B. B. & P.C. for this reason
..
Grading
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby'affirm'that I have a certificate of 'consent to self -insure, ..or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
Policy No. ' - Company
❑ .Copy is filed with the city. O Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
. WORKERS' COM PENSATION.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.
Demolition ❑
AMOUNT -
• t`i (i
Infrastructure
TOTAL $39.00
REMARKS
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become
BY:
' subject to the Workers' Compensation provisions of the Labor Code, you must to
comply with such provisions or this permit shall be deemed revoked.
..ZONE:
,Minimum Setback Distances:
.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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. •
/ *1
12/
I car tify.that I have read this application and state that the above information is correct:
Issued by:
Date ✓ Permit.
I agree to comply with'all city and county ordinances and state laws relating to'building
s
construction, and hereby authorize representatives -of this city to enter the above..
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing,Address -
Validation:
-, v,City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
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. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL