05133 (MFD5)i
4
4
P.O. 4 No. 05133
BOX 150
Building 78-105 CALLE ESTADO
Address 78-145 Crimson Drive LAQUINTA,CALIFORNIA 92253
Owner
ry
Boulevard Development
BUILDING: TYPE CONST. OCC: GRP.-
Mailing
Address777 R. wain st. Q" rm . 6
A.P. Number 613--790-009
City
Zip
Tel. ,.
Orange
92686
714-547-8066
Legal Description
Project Description$aildfn8 33, Plan 2U,
Lot 317
Contractor
Same _
Address
City
Zip
Tela
State Lic.
& Classif. 3112.61
City
Lic. # 1. 17 7 .. _
Sq. Ft. 912 No. No. Dw.
Size Stories Units
Arch.; Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) ?!_Division 3 of the Business and Professions Code, and my license is in full force and
effect ! ��
.SIGNATURE - i'..i . DATE
' OWNEWBUILDER DECLARATION
I hereby affirTn 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 costruct, after, improve, demolish. or repay any structure, prior to its issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Prolessions 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 appfcant to a civilpenalty of not more than five hundred dollars (E500).
❑ 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
bunds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not contended or offered for safe. If, however, the building
or improvement is sok/ within one year of completion, the owner -builder wig have the burden
o1 provig that he did not bund or improve for the purpose of sale-)
Estimated Valuation
$63,225
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 8 275.61
COfISt. 331.00
Mech. \ � (j n ci
Electrical
44.76
Plumbing
75.00
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Buskress and Professions Code: The Contractor's License Law
does no 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.)
❑ I am exempt under Sec -------B. & P.C. for this reason
S.M.I.
4.59
Grading
Driveway Enc.
Date owner
Infrastructure 1.467
X57
y
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.)
Polity No Company
❑ Copy is filed with the city. ❑ Cert -died [ropy is hereby fumished.
TOTAL S ?. 7 1j
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
Arlt x nitt1 I l#40-1
(This section need not be completed B the permit is for one hundred dollars (S 100) valuation
or fess.)
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
_... _
tU Y T t L� I Z 2
72 12. { 1
Date Owner
NOTICE TO APPLICANT: n, after making this Certificate of Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
campy wily such provisions or this Permit shoo be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, C" Code.)
Side Setback from Property Line
Lender's Name
DATE INSPECTOR
12/28/88
Lenders Add!;
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.
1 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.
Issued by: Date Permit
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE O Q
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
GAS (ROUGH)
/
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. Fi.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as Property tax valuation
FRAMING 3'� FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
v"
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. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V/ao
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 II // ELECTRICAL HEATING & AIR COND. SOLAR
rl, ir77y1
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE O Q
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INS ?Q O C/
FRAMING 3'� FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUNDS /
FINISH GRADING
FINAL INSPECTION v
CERT. OCC.
coram MMAI
v"
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL