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07137 (MFD5)T4-tyl 4 4 Q" P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 78-277 Scarlet Court LA QUINTA, CALIFORNIA 92253 Owner Boulevard Developwnt BUILDING: TYPE CONST: Address 777 S. Bain St. Suite 106 City Zip Tel. Orange CA 92686 1 7i4--547-80561 City State Lic. City & Classif.46181 Lic. # Designer Address City IZip I State I 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 Cade, and my license is in full force and effect DATE ow OWNERBUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to life a signed statement that he is licensed pursuant to the provisions of the Conbactals License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or Mat. he is exempt therefrom, and the basis for the alleged exemption. Any vlof3tion of Section 7031.5 by 'any applicant for a permit subjects the appicant to a civilpenally of rpt morethan 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 Licese Law roes 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 rmprovenents are not intended or offered for sale. If, however, the building or improvement is said within one year of completion, the owner -builder will have the burden of proving that he did not braid or irprove 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 appy to an owner of property who builds or krproves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec --------g, & P.C. for this reason Date Owner WORKERS COMPENSATION DECLARATION _ j� r I hereby affirm that I have a certificate of consent"to self -insure, or a ce'toicate,of . Worker's Compensation Insurance, ora certified-copy-Uiereof.'(Sec `3800, Labor Code.) Policy Nopany `✓ r i1r Ii ,. ` ❑Copy is filed with the city. ❑ Certified° py is he ebytumished. 1"r J CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (chis section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not =any ppeerson in any manner so as to become subject to the Workers' Compensation Laws of Calrfamia Date Owner NOTICE TO APPLICANT, fl, after making this certificate of Exemption you should become subject to the workers' compensation provisions of the Labor Code, you must forthwith comply with such provisory or this pemmT 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, Civil Code.) 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 Address City, State, Zip No. OCC: GRP. ©7.37 A.P. Number 613-790-OIA Legal Description BLD #29 Uni t x,275 Project Description Plan I Sq. Ft. 926 No. No. Dw. Size Stories, Units New ❑ Add ❑ Alter ❑ Repair ❑- 'Demolition ❑ Garage included Estimated Valuation $C6,731 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bali 31. ��3 Const. 49Y,.W_ _ Mech. 64.0 Electrical 67,56 Plumbing 112.50 S.M.I. 4.69 Grading Driveway Enc. Infrastructure 1401.4b ^2 r. I S.txr. 315 ,.% REMARKStcr, M n s ; ra rn.r.. fi n...a �_.t•n t_t; ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE IN$REC�T�O�R Issued by: Date -Permit Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE s/�G Q�J .vA ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. Sp. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. Sp. Ff, ® DUCT WORK ROCK STORAGE GAR. SO. FT. @ POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. SQ. FT. ® GAS (FINAL) TEMP. POLE WALL Sp. 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(AUTOXDISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® 3/.c 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 7F UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE s/�G Q�J .vA ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. U 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. FRAMINGI �D �L FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL ILS NG S MESH INSULATIONISOUND7fj/q0 T FINISH GRADING FINAL INSPECTION 9d CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL71 1