07160 (MFD5)Buildin
Address 78-275 Starlet Court
Owner
Boulevard 8evelarlmn
T4'ht 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 777 S. Hain Street Suite 106
City Zip Tel.
Oraw CA.1 92686 71.4-547-81356
Contractor
Sale
Address
State Lic. City
& Classif..461814 Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7=of Division 3 of the Business and Professions Code, and my license Win full force and
SIGNATURE DATE
Cr.� OWNER-BUILDromER DECLARATION
I hereby affirm that I am exempt fthe Contractors License Law for the following
reason (Sec. 7031.5,8rsieess arM PrWessions Code: Any city or county which requires a
Permit 10 construct. after. Improve. 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 Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. hens exempt therefrom, and the basis
for the alleged exemption_ Any violation of Section 7031.5 by 'any applicant for a permit
sub)eds the appli wd to a civil penally or not more than !'live hundred dollars (5500).
❑ 1, 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 Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such inprovemerds are not intended or offered for safe. t, however, the building
orimprovement is sold within one year of completion, the owner -budder wig have the burden
of proving that he did not build or rrwmve for the purpose or sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Busimess and Professions Code: The Contractor's License Law
does not appy to an owner of property who builds or improves thereon, and who contracts for
such pmieds with a contractor(s) licensed 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 affirm that I have a certificate of,;consent to self -insure, or a certificete of
Workers Compensation Insurance, ora certifieb'copy thereof. (Sec. 3800, Labor, Code.)&
Policy No Company Z% i 2k t ,' s',. SIV .1-.�#'�
rtifi
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CEIinFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pend 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 APPUCAM: t, after making Iffs Certificate of Exemption you should become
Si4ect to the Workers' Compensation provisions of the Labor Code. you must forthwith
campy with such provsrons or this pend shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued_ (Sec. 3097, Civil Cade.)
Lenders Name
Lenders Address
This is a building permit when property 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, Addre_sa
city, State Tap
No.
BUILDING: TYPE CONST. OCC:.GRP.
A.P. Number C1�i3'-7�-Ci2
07160
Legal Description ULD #29 Unit #275
Project Description P1 an 21
Sq. Ft. 912 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition. ❑
Estimated Valuation
$65,225
PERMIT�,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S S. 23
Const.
466. so
Mech.
S4.00
Electrical
67.14
Plumbing
112. ou
S.M.I.
Grading.
Driveway Enc.
Infrastructure
is
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 2/21.190 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE �/��
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMINGG
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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 ® 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND7A o 7-t
SQ.FT.GAR ® 3/+c
HOUSE SEWER
FINISH GRADING
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 �/��
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 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.I�
FRAMINGG
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ING � tS
MESH
INSULATIONISOUND7A o 7-t
FINISH GRADING
FINAL INSPECTIONW K to_
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1