07188 (MFD5)Buildin
Address 78--285 Scarlet court
Boulevard Deyelopmnt
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailin
Address 777 S. rain Street Suite 1061
City Zip Tel.
-Orange CA 1 92686 714-547-8056
Contractor
Same
Address
State Lic_I City
8r Classif. 461814 Lic. #
Designer '
Address Tel.
City( Zip ( State I
Lic. #
"LICENSED CONTRACTOR'S DECLARATION I
hereby inn t4l'),am•licensed under provisions of'Chapter 9 (commencing with Section
7001)) of.bnision 3'61 the Business and Professions Code, and my license is in full force and
effect "�� � ...,. � r - �,• j 1 ,
SIGNATURE i ., !'r ... a J
_ _ .-Mti w+. .,� Y DATE
✓r OWNEWBUILDER DECLARATION
I hereby affi0n that I am exempt from the Contractor's License Law for the following
reasorc (Sec. 7031.5,8rsrress and Professions Code: Any city or county which requires a
perm to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
repnes the appFcad for such permit to fide a signed statement that he is licensed pursuant to
the provisions of the Canbactors License Law, Chapter 9 (commencing with Section 7000) of
aNisibn 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
subjects time appicant to a uvi penalty of not more than five hundred dollars ($500).
❑ 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
PlWessions Code: The Contractor's License law does not apply to an owner of property who
bu7ds or improves thereon and who does such work himself or through his own employees,
provided that such wprovemments are not intended or offered for sale. ll, however, the building
or improvement is sold wJW one year of completion, the owner -budder will have the burden
of provemg that he did not build or improve for the purpose of sale.)
❑ 1, 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 apply to an owner of property who builds or improves thereon, and who contracts for
such projects wlth a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sel~ B. F P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION �
I hereby affirm that I have a certificate of consent't'o self -insure, oria certificate 4f
Workers Compensation Insurance,.ora certified_°copy thereof. (Sec: 3000, Labor Code.`)
Policy No Compaim mow, 4 / � � � %
❑ Copy is filed with the city. ❑ Certified copy is heretiy46 fished. -4-16
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars (E 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 APPLICANT: f/, after malmg this Certificate of Exemption you should become
subject to the workers' C NTpensab'on provfskmns of the Labor Code, you must forthwith
comply with such provisions or this 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, 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 thereundewr is suspended for 180 days.
1 oertity that 1 have read this application and state that the above infgrmation 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.
JILDING: TYPE CONST. OCC: GRP.
P. Number
613-790-013
Legal Description BLD #28 Uri t #271
Project Description Plan 31
Sq. Ft. ,� No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 556,886
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
1 2691 }D
Const.
446.00
Mech.
49,50
Electrical
62467
Plumbing
94.50
S. M.I.
.34 g9
Grading
Driveway Enc.
Infrastructure
1,279.94
50
TOTAL
2> Gla. . � � ; � r '
REMARKS
i.t tof't.Jry 3 .•'rJY" ., x r..rw.ks...
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/ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
Sq FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
-Cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP./ G�
C d C
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
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 !oma
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER 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
-Cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP./ G�
C d C
FRAMING —?13 g'Q T
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G�/
LA IN�a �� gQ G�
MESH
INSULATIONISOUND 7 C
FINISH GRADING
FINAL INSPECTION % O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL