05131 (MFD5)T4hf 4
P.O. BOX 1504 N o . 05131
Building 78-105 CALLE ESTADO
Address $— r T) ar- LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Boulevard DeveloDment BUILDING: TYPE CONST. OCC: GRP.
Address 7 R tt Q.a f,.a 1AA A.P. Number 613-790-009
City Zip Tel.
Orange 92686 714-547-8056 Legal Description
Contractor Project Description Btt11.dinft: 32. Plan 217. tnf 10
SAMe
Address
City Zip Tela
State Lic. City
& Classif. 311261 Lic. # 1177 Sq. Ft. 912 No. No. Dw.
Arch., Engr., Size Stii6es Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 he affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect.
bivision 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -Bt IUILDER DECLARATION Estimated ValuationI hereby
reason: (Sec-affirm70b,t IBusiness am rand pProfessions Code: Any Contractor'srorn the of county
fwhicheregluir Sing $65,225
permit to construct, after, improve. demoish, or repair any structure, prior to its issuance also
nagwes live appicant for such permit to fele a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the appicant to a civil penalty of not more than two hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. Q2 75 6 t
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Profession Cade: The Contractor's License Law does not apply to an owner of property who Const. 333 nn
builds or improves thereon and who does such work himself or through his ownemployees, Mech.
provided that such irprovements are not intended or offered for sale. 8, however, the building
or Improvements sold within one year of completion, the owner -builder will have the burden Electrical
of wavig that he did not build or improve for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law r
does not apply to an owner of property who bolds or inproves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) APGrading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure 1,467.57
F . -ge- coed I_. rmrd 38.18
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL S 2.2 7 2.71 t I t l
CERTIFICATE OF EXEMPTION FROM REMARKS T
WORKERS' COMPENSATION INSURANCE l ]
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation Wt7 % u !ttj f
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
aliforniaDate,owner
NOTICE TO APPLICANT: ft, after mating this Certiricate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
cmpty with such provisions or this Permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to 12/28/88 expiration if work thereunder is suspended for 180 days. 12 / 2 8 / 8 8
1 certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. a $
UNITS
�ryI�
SLAB GRADE 'l
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING!
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. Ff.
GROUT
WATER HEATER
WALL SQ. Ff.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.—
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
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
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.
SQ. FT. ® c
BATH TUB
SQ. Fr. ®c
I WATER HEATER t
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
-le
SETBACK
GROUND PLUMBING if -%
J1DERGROUND
A.C. UNIT
COLL. AREA
�ryI�
SLAB GRADE 'l
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER 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
$ —plus—x$_=$
LUMBER GR.
FINAL INSP.—
FRAMING 3/7/10 TO
FINAL INSP.
ROOFING VIVO Q Y
'
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA HING 3
MESH
INSULATIONISOUND 3 R lqo
FINISH GRADING
FINAL INSPECTION-2/3/qv TV
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL