07198 (MFD5)Building 7s°o-229 Scarlet Court
Owner
Boulevard Development
T4'yl 4 .fwQ"
P.O. BOX 1504
78-105 CALLE ESTADO
-LA QUINTA, CALIFORNIA 92253
Address 777 S. Main Street Stone 106
City Zip Tel.
Orange CA 92686 714-547-0055
Address
Zip
State Lic. City
& Classif. 451814 Lic. #
Arch., Engr.,
Designer
Address I Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
e70ff0� of bnnsioon 3'of the Business and Professions Code, and my�licyense is in full force and
SIGNATURE..�'� 4 pt:,.•+':r£+'' /�P,..- DATE
OWNEWBUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason- (Sec. 7031.S,BuShM arid Professions Code: Any city or county which requires a
permit to construct, ater, rrprove. demolish, or repair any structure, prior to its issuance also
requires Me applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, arch the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Protessiarrs 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 inprovements are not intended or offered for sale. If, however, the building
or improvement is said wthir 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 conbactor(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 #/
1 hereby affirm that I have a certificate oi�consenl°to self -insure, or a certificate of
Worker s Compensation Insurance,, or a certified,cop'y thereof. (Sec. 3800, Labor'Codeg'
Policy No Company �� %u ,� 1S �✓e• '`
❑ Copy is filed with the city. ❑ CeAified cos hereby-furnlshed—
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg'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: ft, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
c0mpfY with such Provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that tyre 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
L
xpiration 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 properly for inspection purposes.
Signature of applicant Date
Mailing Addrrss
City, State, Tip
No. 07198
11LDING: TYPE CONST. OCC: GRP.
P. Number 613-790-0.12
,Legal Description BLD #31 Unit $299
Project Description P1 an 3U
Sq. Ft. 7i 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 2/21/90 Permit
Validated by -
Validation:
Estimated Valuation $56,886
PERMIT' —1,
AMOUNT -
Plan Chk. Dep.
Plan Chk. Bal.
$ 289.30
Const.
446.00
Mech.
49.50
Electrical
62.67
Plumbing
94.50
S.M.I.
3.99
Grading
Driveway Enc.
Infrastructure
1,279, 94
TOTAL
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 2/21/90 Permit
Validated by -
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE Liv
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
MOB]LEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. Fr. ®
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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 Liv
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. Sit/ c?e
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. B
FRAMING
FINAL INSP.
ROOFING
��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RING O �j
MESH
INSULATIONISOUND 5
FINISH GRADING
FINAL INSPECTION/ 3 O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL