04147 (MFD5)Building 78-021 Cobalt Drive
Owner
Boulevard Development
Mailing
Address 777 S. main Street
City Zip
Oranala 1 92686
Contractor
same
Address
Same
State Lic.
& Classif. 462814
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
" BUILDING: TYPE CONST.
OCC. GRP.
04147
Suite -106 A.P. Number 613-790-008
Tel.
714 -547 -BOSS Legal Description
Project Description Building 19 • Plan 1
Tel.
City ;
Lic. # M Sq. Ft. 9M No. ., No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair O Demolition ❑
Tel. Garage included
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I he affirm that I am licensed under provisions of dhapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. ,.r°e `G� ?i- t' .. s �Cr G •%...•'
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 'requlres a
permit • to construct, after, 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 Cade, 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 ($500).
O 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--fhe 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
orimprovement 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.)
O 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O 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 ($100) valuation
or less.)
I 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., If, 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 for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a bullding 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
,timated Valuation
$66031
PERMIT
AMOUNT
Plan Chk.,Dep.
Plan Chk. Bal.
Const.
3349.00
Mech.
36.00
Electrical
45.04
Plumbing
75.00
S.M.I.
4.66
Grading
Driveway Enc.
Infrastructure
1o501.45
7,rinnn- Toad
L, zard
TOTAL
512.15
REMARKS
4E�rJR1eLt'Y d`'TTa.�� 4�u-pith fR:aJ
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 INSP_FyTO�R}
Issued by: Date _ Permit
Validated by:
Validation:
- 1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENi100 • 6666SSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO.. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO F1 (p $
UNITS
COLL. AREA
SLAB GRADE (
„
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINFe /
POWER OUTLET
ROOF DRAINS
GARSO. FT.
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SO FT. 6
'
WALL SO. FT. a
DRINKING FOUNTAIN
SERVICE
FINAL INSP.
URINAL
SO. FT. (4
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOYDISH)
APPLIANCE DRYER
REMARKS:
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1'A c
SEWAGE DISPOSAL
MESH
INSULATIONISOUND
FINISH GRADING
SO.FT.GAR rg. 3i.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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (
„
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINFe /
/ __
GAS (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. yd.
$ plus x$
= $ '
LUMBER GR.
FINAL INSP.
FRAMING �/ O
FINAL INSP.
ROOFING
.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING (
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL