05142 (MFD5)T4tyiiii 4 4 Q"
P.O. BOX 1504
Building 78` 131 Criasiou Drives LA.QUINTA_CCALIFORNIAALLE 92253
DO
Address _ _..... .
Owner
Boulevar4 DavelQpment BUILDING: TYPE CONST
Address
777
kt'a.
City Zip
City
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
331261
7R'L..�S�.7•.
Tela
City
Lic.# y;,7
Tel.
State
Lic. #
No.
OCC: GRP.
,.P. Number
05142
Legal Description
Project Descriptions -g 13 A$ 3 2 V1 nz 31 1 a~ 31 0
Sq. Ft. 763 No. No. Dw.
` SizeStories' Units"
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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
effect � .✓7^ I f " I a A. 11 1 6. r� T
SIGNATURE 4 — • -' "/ " K. `.e e ",r � DATET
OWNEWBUILDER DECLARATION
I hereby affign that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usrress and Professions Code: Any city or county which requires a
Permit to construct, ata, rrgrove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pend to lire a signed statement that he is licensed pursuant to
the provisions of the Contactors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Buskiess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged-exorptjon- Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to acovil peaty 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: The Conbactorls 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 Mat such irprovemerts are not intended or offered for sale. If, however, the building
or improvement is sold w&A ane year of completion, the owner -builder will have the burden
of proving that he did not build orrrprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Brtiness and Professions Code: The Contractor's license Law
does not appy 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 a- & 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- ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed B the permit is for one hundred dollars ($100) 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 Califomia
Date Owner
NOTICE TO APPLICANT: /, after mating this Certificate of Exemption you should become
subject to the Workers' Conpesation provisions of the Labor Code, you must forthwith
compy with such pov4sios or OVS peed shad 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, C d Code.)
Lender's Name
Lender's Address
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.
I certify that 1 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
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 INSPECTOR
Issued by- Date 12/28/8 -Permit
Validated by:
,Validation:
3timated Valuation
$56.886
PERMIT'
AMOUNT
Plan Chk. Dep.
Plan Chk. Bala
Const.
a y f3
�a3
Mech.
.00
Electrical ' '
A I 7A
Plumbing
00
S.M.I.
Grading
Driveway Enc.
Infrastructure
1 .2 V) 94
t?7r ares..ri'na►I 11JrTkrJ,
'1 R
TOTAL
REMARKS
v '
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 INSPECTOR
Issued by- Date 12/28/8 -Permit
Validated by:
,Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE %le�
OUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ -Plus-X$-=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP-?6d
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
INSULATIONISOUND
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE %le�
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �LI�
GAS (ROUGH)
for
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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-?6d
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 3
LATHING 4
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
'
GARDEN WALL FINAL