07139 (MFD5)Addrdess 78-257 Scarlet Court
Owner
Boulevard Devel
Address 777 S. Main St.
City Zip
Orme CR 92686
Sam
Address
T4_hf - 4 4 Qabt&
Suite 106
Tela
State Lic. I City
& Classif.461814 Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 07.99
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number 6113-79D-012
714-547-8056 Legal Description OL# 30D Unit 285
Project Description Plan 1
City Zip State
Lic. # r
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 full force and
effect.
_SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiress and Professions Code: Any city or county which requires a
Permit to construct. after, iryrove. demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the CanbaUors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Rofessions Code, or that. he is exempt therefrom, and the basis
for the alleged exanption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applIcant to a civil penally of not more Man 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 Contractors 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 improvements are not Intended or offered for safe. N, however, the building
orimprovement is said widen one year of completion, the owner -builder will have the burden
of proving that he did not braid orimprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to com.
struct the project (Sec. 7044, liar 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 contractarfs) Ncensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. a, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirrn that 1 have a certificate of tconsent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified�46py thereof. (Sec: 3800 Labor Code:j'
Policy No.
Company
`. • f i /� -+
[I Copy is filed with the ally. ❑Certified capy.is tierebyfumish`ed.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMMOTION INSURANCE
(This section need not be conpM.ted 8 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 persrnion in any manner so as to become subject to the Workers' Compensation
Laws of Cali foa.
Date' Owner
NOTICE TO APPLICANT: 8, after malamg Mfs Certificate of Exemption you should become
subject to the Workers' Cor persatim pruv5ions of the Labor Code, you must forthwith
comply with such provisions Or Drs permit shall 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, Chd Code.)
Lender's 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
Sq. Ft. 926 No. No. Dw.
Size • Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Garage 'included
f
Estimated Valuation $58,731
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
°� e
Mech.
Uig
Electrical -
01.40
Plumbing
t1L.
S. M.I.
4. UNA
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS }�yy
zVl��I_J 4r'' 1 4-
t
t .fl .Yw+7l:)-V-tit i V
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 INSP.gCTORR
Issued.by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. 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. SQ, FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT. ®
DRINKING FOUNTAIN
GROUT
WATER HEATER
URINAL
SO FT
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
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, TEWPERM
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 ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 PLUMBING m
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.
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
yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. G <,-cu.
FRAMING -5 4��t�
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. 41REWALL
LATHING % 3 i0 %
MESH
INSULATIONISOUN �b
FINISH GRADING
FINAL INSPECTION S
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL