07183 (MFD5)4
P.O. BOX 1504 NO, 07283
BuilinAddress 78-317 Scarlet Court LA QUINTA, CALIFORNIA 92253
Owner I
Boulevard Develomnt
Address 777 S. Main Street Suite 106
City Zip Tel.
Orange CA 92686 714-547-0056
Same
BUILDING: TYPE CONST. OCC: GRP. -
A.P. Number 613-790-013
Legal Description OLD #27 Unit #260
Project Description Plant A
City
Zip
Tela
State Lic.
City
& Classif. 461014
Lic. #
Sq. Ft. No. No. Dw.
Size 753.. Stories Units
Arch., Engr.,
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Designer
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 in full force and
effecL`.�;:- �
^
SIGNATURE ` - _ - -' �-" DATE
r OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busimess 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 appficant for such permit to rile 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. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally or not more than rive 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
Code: The Contractor's 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 sale. It, however, the building
or improvement is sok/ within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation �S6 X86
PERMIT AMOUNT
`
Plan Chk. Dep'.
Plan Chk. Bal. «�
Const.Professions !
Mech. 49• it
Electrical .6. ,jj7
c
Plumbing 94.50
❑ 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 properly who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
S.M.I.
Grading
Driveway Enc.
Date owner
Infrastructure 1,279.94
WORKERS' COMPENSATION DECLARATION
I her affirm that I have a -certificate of consent`to self-insure,�or a certificate of
Workers Compensation Insurance, orraacertified copy thereof. (Sec. 3800, Labor Code.) q
Policy No Company%
❑ Copy is filed with the cit ty.❑ rCe,rtified co ihheeby- fnished: °`---TT
Elk' -
TOTAL v a +-�-
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
) completed ff, the permit is for one hundred dollars ($100) valuation
(rns Section need not be
I certify that in the performance of thg work for which this permit is issued, I shall not
employ anyppeerson in any manner so as to become subject to the Workers' Compensation
Laws of Califomia.
REMARKS . - .._ 1 fj
•t-•�f�f'9}AT}Y''f
Date Owner
NOTICE TO APPLICANT: ff, 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 Provisions Orthis Permit Shall bedeemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE qINSP4ECTnOR
G�1lai
`i'
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.
1 car tity that I have read this application and state that the above information is correct.
1 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.
Issued by: Date Permit
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® =
UNITS
SLAB GRADE ��/tel
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. Fr. ®
AS (ROUGH)
ez
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. Ff.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION E
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING 7l "' a r
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ®c I
IBATH TUB
SQ. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
�ny
INSULATION/SOUND -L qQ L
SO.FT.GAR ® V4c
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 ��/tel
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 51-1
AS (ROUGH)
ez
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.
g —plus—x$—=$
LUMBER GR.
FINAL INSP.
FRAMING 7l "' a r
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING i7 Qt1
MESH
�ny
INSULATION/SOUND -L qQ L
FINISH GRADING
FINAL INSPECTION/ �V O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL