04290 (MFD5)04290
P.O. BOX 1504
Building 78"'0Cobalt Drive LA QUINTA78-105 CCALIFORNIA92253
Address .
Owner I
Bau.1evard Dev&].opment N
mailing
Address 777 8,
City
Orange
Contractor
Same
Address
City
BUILDING: TYPE -CONST. OCC. GRP.
A.P. Number 6'.3-794-007
Zip Tel.
92686 914µ547»8056 Legal Description
Project Description ln 3. Building 18
Tel.
State Lic.�'4 (City
& Classif. Lic. #.
Arch., Engr.,
Designer
Address Tel.
tyI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
I
R�'` ��,�.�y 4.,:t��.�^t:.�T•L:?''•��..
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file 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 civil penalty of not more than five hundred dollars (8500).
❑ 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 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. If, however, the building
or Improvement is sold 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.)
❑ 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 apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
''Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent toll'self-insure, or a certificate of
Worker's Compensation Insurance, or a certified,cd'oy thereof. (Sec '3800, Labor Code.)
Policy No. Company > r J «
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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 APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or 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.)
Lender's Name
Lender's 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.
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
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
,Sq. t. • - - 9g -
Size
. No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
'� • 1
Const.
•�
Mech.
g
Electrical
•
Plumbing
• t
S.M.I.•t%
Grading
Driveway Enc.
~
Infrastructure
�.x a►tx� t� — .P: p"u6.;6
!P27 • `�
Ott ,l6. W a? t7 s dL tI
TOTAL4:�V
REMARKS
09 5{Wo, RF -0 ` g �/
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 DATEINS PRE�C�TO�R
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE •�
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FTW S
UNITS F
SLAB GRADE % ?¢3
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. @
FORMS
ol
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR SO FT. @
C G (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET ..
ROOF DRAINS
GAR SO. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. @
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu.,ytl.
$ plus x$
,
_$
URINAL
SO. FT. @
FRAMING
(((/
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN ,
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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.
SO. FT. @ c
BATH TUB
INSULATION/SOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/.c
HOUSE SEWER
"
CERT. OCC.
GAS PIPING
PERMIT FEE
FENCE FINAL
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. =EE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING e ELECTRICAL HEATING 8 AIR COND. SOLAR
OTOcAw ..
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE % ?¢3
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ol
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �9
((
C G (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP. -
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.,ytl.
$ plus x$
,
_$
LUMBER GR.
FINAL INSP. 1211fi 7/
S
FRAMING
(((/
FINAL INSP.
ROOFING
/
REMARKS:
VENTILATION
'FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINIS-a I /� y
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
"
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL