07180 (MFD5)Building
r
Owner
Boulevard Devei
(f,i-tit 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 777 S. Main Street Solite 106
City Zip Tel.
Orange CA 1 32686 1 714-647-8056
City
State Lic. I City
& Classif.461814 Lic. #
Arch., Engr.,
Designer
Address Tel.
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 Code, and rfly IicAnse is in full force and
SIGNATURE. / K+ `.s, 1 '+ _.,r -, h� 0 r �..� DATE
4 r OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reasofr fSec. 7031.5,Business and Professions Code: Any city or county which requires a
pemit to construct. ager. Improve, demolish, or repair any structure, poor to its issuance also
requkes Me applicant for such permit to file a signed statement that he is licensed pursuant to
Me pmvsious of the Contractor's License Law, Chapter 9 (commenting wffh Section 7000) of
Df si 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for Me alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects life appllant to a cavil penalty of not more than foe 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, Suisness and
Rolessons Cade: 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. ff, however, the building
or irVnwement is sold within one year of completion, the owner -builder wig have the burden
of proving that he dud 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 Comractoes License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1bY affirm that I have a certificate of consent.to self -insure, or a certificate df
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labo/Code)
Policy No Company't/ r ' /•' _ L>>%/.a fi `e..
❑ Copy is filed with the city. ❑Certified copy is hereby furnished. v a
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
s� need not be completed if the pemrut is for one hundred dW6 ($100) valuation
or certify that in the performance of tha 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 Califomia
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 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 far which this permit is issued. (Sec. 3097, CM Code.)
Lender's Name
Lender's 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 infgmmation 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. 07180
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
613-793-013
BLD #26 Unit
Plat)
#252
Sq. Ft. 7�3
Size
No.
Stories
No. DW.
Units
New ❑ ' Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
569886
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
2 0
Const.
`
44fi00
Mech.
49.50
Electrical
67 F47
Plumbing
94.50
S.M.I.
3.99
Grading
Driveway Enc.
Infrastructure
!,Z79.94
TOTAL
REMARKS
r1T a=�ifi�r.�`�—atM`�'�^►t r:e�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--
Y
FINAL DATE INSPECTOR
-issued by: 2/21/90 Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE �iJ�(
�(�
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
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LA ILj
NG
SQ.FT.GAR ® 3/ic
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �iJ�(
�(�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. /"�
s/
?
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_
FRAMING O /
�c
FINAL INSP.
ROOFING
,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA ILj
NG
MESH
INSULATIONISOUND Q L
FINISH GRADING
FINAL INSPECTION �'yd
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL