003182 (BLCK)44a
P.O. BOX 1504 N o . 003182
Building 78-105 CALLE ESTADO
Address 54-520 Ramirez LA QUINTA, CALIFORNIA 92253
Owner
N44IZVt Whitlow BUILDING: TYPE CONST: OCC: GRP.
Mailing _
Address A.P. Number 7%4-275-013.1
City Zip - Tel.
Ta Oul. � 922.53 '34"664 Legal Description
Contractor _ Project Description's taini%aI1 :Qtgb
Address
"7&_2Y•19t5 >l1'.s7 4 RSaV
.City, . - Zip p... Tela
Palm Des -ort 92260 346--U64
State Lic. ' City
& Classif.Lic. # Sq. Ft. No. No. Dw.
926 Size Stories Units
Arch., Engr: _
Designer New ❑~- ":T Add ❑ ' Alter ❑: Repair ❑ Demolition ❑
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 _ ,• - - —
OWNEWBUILDER DECLARATIONEstimated Valuation
I hereby affirm that I am exempt from the Contractor's License Caw for the following ��.fy
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county .which requires -a _ <
M.
permit to construct; alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that 'he Is licensed pursuant to •. PERMIT - AMOUNT
the provisions of the Contractor's License Law,, Chapter 9 (commencing with Section 7000) or ✓
Division 3'of the Business and'Profess"ions 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 p_ ermit. Plan Chk.. Dep. -
subjects the applicant to a civi penalty of not more than rive hundred dollars ($500): plan Chk. i3al.
O 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, Buisriess and Const.°fl
Professions Code: The -Contractor's License Law does.not apply to an:owner of property who +
builds or Inproves thereon and who does such work .himself or through, his own employees, Mech.
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 'Electrical
or proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner -of the property, am exclusively contracting with licensed contractors to con- - Plumbing
struet 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.) -
Grading
O 1 am exempt under Sec. B. & P.C. for this -reason
Driveway Enc.
Date Owner 'r' . --~ Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, of a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Lab6r Code.)
Policy No. Company
O. Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKSi>1y
WORKERS' COMPENSATION INSURANCE a +^n' Alst r>. • •1 N.. fi• _ t ).
(This section need not be completed it 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
Date' Owner
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become ZONE: BY:
subject to' the Workers' Compensation provisions or 'the Labor ' Code, you must forthwith -
comply with such provisions or this permit shall be deemed revoked. 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 it work thereunder is suspended for 180 days. "
I certify that I have read this application and state that the above information is correct. Issued by: Date fi-1155197 Permit
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. Val (dated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
RMS 1114�lN14-' tj
WATER SOFTENER '
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
Ir—
+ •�
a ®EC .7.
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS 1114�lN14-' tj
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
A& S (FINAL) � ^� �
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
n
BOND BEAM 6 g /
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
Ir—
+ •�
a ®EC .7.
IS
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
s
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL- INSPECTION
CERT. OCCs
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS•
GARDEN WALL FINAL