07170 (MFD5)P.O. BOX 1504 N Q . 07170
O
Building 7&105 CALLE ESTADO .
Address 78-233 5rirlet Court LA QUINTA, CALIFORNIA 92253
Owner
Boulevard Deve}opwnt -
Mailing BUILDING:;TYPE CONST: OCC:.GRP.
Address 777 S. Elam Street SUfte 106 A.P. Number 613-790-012
City Zip Tel.
.. Orange CA -92686 1.,714-547-8056 Legal Description BLL $r''3$ Unit ,1 297 -
ContractorPian 2U' .
Same . Project Description
Address,
City Zip Tel.: `
State Lic. City
& Classif.+6}814 Lic. # Sq. Ft.. .912.. No. No. Dw.
Arch.; Engr., Size Stories Units
Designer New ❑ .-Add ❑' Alter ❑. Repair ❑ 'Demolition If
Address- Tel.
City Zip State
Lic. #
_.-LICENSED CONTRACTOR'S DECLARATION '
' I hereby affirm that 1;a n licensed nu der provisions of Chapter 9'(commencing with Section
7000)'of Division_3 of-.the,Busine§§ and Professions'Code, and /my license is in full force and
effect , x• ! ., ( ; 1 7' , .,
SIGNATURE .J• l:" '., DATE
OWNFJ48UILDER DECLARATION
I hereby affirfn1h�at I am exempt from the Contractor's License Law for the following Estimated Valuation ��� ��
reason: (Sec. 7031.5.8usiness'and Professions Code: Any, city or county which requires. a - til
.. 5 7
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also -
requires the applicant for such permit to life a signedstatement that he is licensed pursuant to PERMIT AMOUNT -
the provisions of the Conlrwfors 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 vblation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.,
subjects the appicard to a civ8 penalty of not more than rive hundred dollars ($500).
tY
0. 1, as owner of the property, or my employees with wages as their sole compensation, will Plan ,Chk. Bal. - 1 123
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and const.
''Professions 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, -
Mech. -
provided that such improvements are not intended or offered for sale. tf, however, the building �`
or improvement is sold wifth one year of completion, the owner -budder will have the burden Electrical ' ` -67.14
of proving that he did not build or. improve for the purpose of sale.) -
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing • �Ei
- 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. ' 14 IC
such projacts with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec -13. Grading. & P.C: for this reason ,
Driveway Enc. .
Date owner Infrastructure 7.57
-
WORKERS' COMPENSATION,DECLARATION
I hereby affirm that I have a.certificate of consenhto'' self -insure, or a certificate,pf
Workers Compensation insurancei:or,acertified�copy theieof.,(Se03800,-Labor Codej,,,
Policy No.
Comp�y `�f!7>#'✓ ��s
0 Copy is filed with the city. Cl Ce✓rtified'bopyis''-6 shid.! s t
TOTAL m�MJLf': v.Z`:X t' �'. ( !
CERTIFICATE OF EXEMPTION FROM.REMARKS nnr. i.:§n :a '!r: ,cn r:A__�f.•11a dti
WORKERS' COMPENSATION INSURANCE . F
• (rb's section need not be completed i/ the Permit is /or one hundred dollars ($100) valuationV Ll'f�1T�Y�'jti)f Pji.. ..w w«.3ii
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
NO710E TO APPLICANT: N,after making this Certificate of Exemption you should become -ZONE:- m BY: �
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
oo<nprywith such provisions ofLftPemmnshaibedeemedrevoked. 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
Lenders Name
Lenders Address
This is a building permit when properly filled outi signed and validated, and is subject to : FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. -121t/90
1 certify 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
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:.••
City.. State, Zip R ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 7 Z �J�
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
-...,d.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
, I
V
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 PLUMBI G
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7 Z �J�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 5 4�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
-...,d.
$ plus x$
=$
LUMBER GR.
FINAL INSP.`
FRAMING f 90
FINAL INSP.
ROOFING
, I
V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�[
LA ING 6 T p
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION/,/ _
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITU\LS
'
GARDEN WALL FINAL