07142 (MFD5)AddtlPns 78-219 Scarlet Court
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Boulevard Developwnt
Mailin
Address 777 S. Main St, Suite 105
•
City Zip Tel.
Orange GA 1 92686 1 714-547-8056
Contractor
City
State Lic.
& Classif-461814
Arch., Engr.,
Designer
Address
Zip Tel.
No. 07142
LDING: TYPE CONST. OCC: GRP.-
, Number 613-793-012
Legal Description_
Project Description
BLD #31 Unit #304
Plan 1
k1rry
Lic. # Sq. Ft. 926 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel. I Garage included
City( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commending with Section
7000) of Division 3 of the°Business and Professions Code, and my license'is in full force and
effect.'''_ __� Y _ - .
SIGNATURE /' >' f' - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to constnrct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to 0778 a signed statement that hes ilcansed 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 Mat. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or bnproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. H, 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 bnprove 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 Contractors License Law
does not apply to an owner of property who builds or enproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirmthatI have a certificate of_consin to self -insure_, ora certificate
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, -'Labor Code.)/
Policy No. Company >'.r'r'
❑ Copy is filed with the city. ❑ Certifiedlcopyiisherebyf rn hed, r
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.)
1 certify that in the performance of thg work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, 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 this permit shaft be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lenders Name
Lenders 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
(Estimated Valuation $66,731
PERMIT
Plan Chk. Dep.\
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
r Jivil
491.150
54xii
t1 ♦96
4,
.11,W1,45
AM
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 '
INS C O
/
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
nGROUND
SLAB GRADE f QD/
ROUGH PLUMB. BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SO. FT.
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER HEATER SERVICE
FINAL INSP.
WALL SO. Ff.
BOND BEAM
DRINKING FOUNTAIN
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$ _$
URINAL
SO FT ®
��JJ
FRAMING /i.�.J QW
VV
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOKDISH)
APPLIANCE DRYER
SPARK ARRESTOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
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
I VY
PLUMBING OA,' UNDERGROUND
A.C. UNIT
COLL, AREA
nGROUND
SLAB GRADE f QD/
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. K4 7 e
1
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
f
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$ _$
LUMBER GR.
FINAL INSP. 3 O
��JJ
FRAMING /i.�.J QW
VV
FINAL INSP.
ROOFING
6
% ✓ �'//
/to /
^ )
/`�
i�
f � � � �/7 �®
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA11HING 7
MESH
nn
INSULATIONISOUN e✓/� 9�
FINISH GRADING—
FINAL INSPECTION �-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL