07168 (MFD5)44 Q"
P.O. BOX 1504 N o . 07168
Addrdess luilDO
78-241 Scarlet Court LA QUINin TACCCALIFORALLE NIA 92253
Owner
Boulevard Developmirit BUILDING: TYPE CONST.
Mailing OCC: GRP.
Address 777 S. Main Street Suite 146 A.P. Number 513-790-012
City Zip Tel.
Orange CA 92686 714-547-84 55 Legal Description OLD #30fttaii t #293
Contractor
SameProject Description Plr'i:9 2U .
Address
City Zip Tela
State Lic. City
& Classif.461814 Lic. # Sq. Ft. 912 No. No. Dw.
Arch-, Engr., Size Stories Units
Designer New ❑ 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 )n full force and
M - —" J
SIGNATURE t R 'y DATE
4/ OWNER -BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law for the following Estimated Valuation t qq.f
reason: (sec. 7031.5.8siness and Professions Code: Any city or county which requires a #65.225
Permit to construct, alter, krprove, demolish '
em lsh, or repair any structure, prior to its issuance also
requires the apipicard for such Permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors License Law, Chapter9 (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 Plan Chk. Dep.
subjects the applicant to a civilpenalty of not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $ 316.23
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and pa fj
Professions Code: The Contractor'sConst. License Law does not apply to an owner of property who 48 • 0
build or krproves thereon and who does such work himself or through his own employees, such Mech. 00
provided that sukrprovements are not Intended or offered for sale. If, however, the building •
or inprovameht is said wilft one year of completion, the owner -builder will have the burden Electrical 67.14
y �E
of proving that he did not buil or krp6rove for the purpose of sale.) . 14
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 112.50
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law c
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 4.52
such projects with a cmtractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec g- & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 1,467.57
WORKERS' COMPENSATION DECLARATION f
hereby affirm that I have a -certificate of'consent to silt -insure, or a certificate of
Workers Compensation Insurance,. ora certified, copy thereof. -(Sec. 3800, Labor Code.`)
Policy No
—Companyr l ' T *l i - ris_ % .� 4
❑ Copy is filed with the city.❑Certified copy iS hereby furnished. Fr"
. - TOTAL $21ud.56
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed fl the permit is for one hundred dollars ($100) valuation
or less.)
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 APPLICAM.- If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the ftrkers' Compensation provisions of the Labor Code, you must forthwith
comply with such Provisions orthis permit shall bedeemed revoked. Minimum Setback Distances:
Feont Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby 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
Lendees Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days2/21/90
rq ' ty
I cartity that I have read this application and state that the above information is correct. Issued by: Date G L7 Permit
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. Validated by:
Signature of applicant Date
Mailing Add mss Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN,
SQ FT ®
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(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�v
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, BT.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
—7
TOTAL FEES
MICRO FEE
1
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
%�i�—�4�t—a
SETBACK
GROUND PL I
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. A 1l�
!C/
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
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP d L
FRAMINGr�
J
FINAL INSP.
ROOFING
�v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
W f
LAT ING ID
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION g
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t