05144 (MFD5)T4h
4a"
P.O. BOX 1504 N o . 05144
Building 78-105 CALLE ESTADO
Address 78"'151 Crimson Drive LA QUINTA, CALIFORNIA 92253
Owner
Boulevard Development BUILDING: -TYPE CONST.
Mailing OCC: GRP.
Address 777 C, Valri qr, *;ts rp InA A.P. Number Ati-7an- nnQ
City Zip Tel.
Legal Description
Contractor
Project Description. z T at
320
Address"' -
y s
City Zip Tela
State Lic. City
& Classif. 311261 Lic. # 1177 Sq. Ft. 763 No. No. Dw.
Arch., Engr., Size ^' Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of,Divislon 3:of the Business and Professions Code, and my license is in full force and
effect. F
SIGNATURE' ?' ✓'-" ✓- •'c.'V DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation CD
reason: (Sec. 7031.5,Bushoss and Professions Code: Any city or county which requires a s D
permit to construct, after, improve, demolish, or repair any structure, pnor to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License taw, 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 Plan Chk. Dep.
subjects the applicant to a cw7 penalty of not more Man five hundred dogars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S 251 8
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractors License taw does not apply to an owner of property who 0 a
builds or improves thereon and who does such work himself or through his own employees, Mech.
provided that such irprovements aro not intended or offered for sale" If, however, the building
or improvement is sold within one year of completion, the owner-buider will have the burden Electrical Al 7Aof proving that he did not buil or improve for the purpose of safe.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
c
struct the project (Se7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bulls or improves thereon, and who contracts for S.M.I. 11
such projects with a contractor(s) ieersed pursuant to the Contractors License Law.)
Grading
❑ I am exempt under Sec_ H. & P.C" for this reason
Driveway Enc.
Date owner Infrastructure 1,279.94
WORKERS COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city- ❑ Certified copy is hereby furnished.
TOTAL 7 r r
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS COMPENSATION INSURANCE
(This sermon need not be conpleled d the pemrl is for one hundred dollars (E 100) valuation {v;1Ft Qi'? 44 2"1$O i/}
or less \ $ v. t. ow
Iperformancertify that in the performance of Tlrp 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 Califomm
Date Owner
NOTICE TO APPLICANT: f, after making Iles certificate of Exemption you should become ZONE: BY:
subject to the Workers' Cauprinsafion provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shelf 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
Lender's Name
Lenders Address
FINAL DATE
INSPECTOR
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.
12/28/88
1 certity that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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
Validated by:
Signature of applicant— —Date—
ateMailing
MailingAddress
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE t1le4'5�9
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Sp. FT. ®
GAS (FINAL)
WALL SQ. FT. ®
DRINKING FOUNTAIN,
GROUT
URINAL
SQ FT ®
SERVICE
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
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
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
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 PLUMBIN //--.. ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLU ING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE t1le4'5�9
�POUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSh
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. /JIle?,7v ®
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
yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP. J2d r1 Digcu.
111
FRAMING /'� (�^��
FINAL INSP.
ROOFING
Q✓r1
��Cx%/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND?,
FINISH GRADING
FINAL INSPECTION-')
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIAIS
'
GARDEN WALL FINAL
1