07199 (MFD5)Building
Address 78_227 Scarlet Court
Boulevard Deveiopca
Mailing
Address 777 S. Main Street
City Zip
Orange CA 92636
Same`
Address
State Lid.
& Classif.461814
_i Arch., Engr.,
Designer
Address
(f,i-tit 4 4 C1"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Suite 106
714-547-8066
Lic. #
Tel.
City IZip I 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 fuqll force and
effect. � S`".ti.F• r . �.c � �•�f�,r:l%r�
_SIGNATURE 1 ..�' -i°' y F . DATE
`OWNER BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busshess and Professions Code: Any city or county which requires a
permit to construct, after, hVrove, denrofsfh'or repair any structure, prior to its issuance also
requires the applicant for such permit to We 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 vicfatio n of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a awl penally of riot 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, Suisness and
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or #Wmves thereon and who does such work himself or through his own employees,
provided that such improvements are not blended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-0uffder will have the burden
of 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-
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.)
❑ 1 am exempt under Sec_ R. & P.C. for this reason
Date owner
WORKS RS' COMPENSATION DECLARATION
I 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 - f \ - ,/- k, fit
❑ Copy is filed with the city. ❑ Certified copy ishereby fumished. {'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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, 1 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. 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 Otis permit shag 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.)
Lenders 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.
1 certify that 1 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 orf this city to enter the above.
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, State, Zip
No. 07199
BUILDING: TYPE CONST. . _OCC: GRP.
A.P, Number
Legal Description
Project Description
623-790-012
PILD #3I Uni d
Plan'3L
1,410
Sq. Ft.
Size 763 . .
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
$56; 886
PERMITS
N
AMOUNT
Plan Chk. Dep. `
Plan Chk. Bal.
Const.
446.On
Mech.
49.5U
Electrical
-
6.67
Plumbing
94.50
S.M.I.
3.99
Grading
Driveway Enc.
Infrastructure
1,2 9.94
TOTAL
REMARKS %,,=�- MI A 1 1r, rA, 4G _.�.e 110Air " ;WN }" fit IAL 3 - , z.°d ;J',
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
2/21/90
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
COLL AREA
SLAB GRADE S(3 �QdQ
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. Sp. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. Sp, FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT. ®
DRINKING FOUNTAIN
SQFT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ -Plus-X$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Vic
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE S(3 �QdQ
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
, !
FOUND. REINF.`� �O
'1
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 INSPa j3ho Lb
FRAMING ybFINAL
IF
INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA X ING ) 3 &a
MESH
I NSULATIONISOUND 6
FINISH GRADING
FINAL INSPECTION abZ0 L /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t