04229 (GRES)Building 78-327 Terni 4 CAtt4 Ct.
Owner
Boulev d Development
P.O. BOX 1504
78-105 CALLE ESTADO
LA OUINTA, CALIFORNIA 92253
Mailing ;
Address ti 77 .S.* Main St. rr _ Suit* Id6, -
City Zip Tel. ,
Orange ' 92686 1714-5448456-
Contractor
Address
ity Izip Tel.
State Lica City
& Classif. 46814 Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that.l am licensed under provisions of Chapter 9 (commencing with Section
7000) of.
3 of the Business and Professions Code, and my license is in full force and
effect. _- r • a t '
SIGNATURE' - "'�" �' fDATE
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 requires a
permit to construct, atter, 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 Code, or thathe 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 (8500).
❑ 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
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
or improvement 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.)
❑ 1, 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.)
❑ 1 am exempt under Sec. B. ti 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
❑ Copy is filed with the city. ❑ 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 (5100) 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 California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subjectto 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.)
04229
BUILDING:"TYPE CONST.' OCC. GRP.
A.P. Number"'�•"$�
,Legal Description
Project Description V Ruildina 9; Plan I
Sq. Ft.No. No. Dw.
Size» . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Gttrage included
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 251081.
Const. 304.00 -.
Mech. 33.1310
Electrical
Plumbing 63.00
S.M.I. 3 a 96
Grading
Driveway Enc.
Infrastructure
TOTAL y' fS17►`+t o rr . �.. ' i i r,~
REMARKS
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
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
6/29/68
1 certify that 1 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
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK-- APPLICANT, GREEN - BUILDING, GOLDENROD -ASSESSOR'S OFFICE, HARD COPY,- FILE,
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. I PLUMBING FEES
IST FL SO Fl <a $
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR SO FT a
DUCT WORK
ROCK STORAGE
UND. NF/r_
I
POWER OUTLET
ROOF DRAINS
GAR SO. FT. a
OTHER APP.IEOUIF.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. Q
GROUT
WATER HEATER
SERVICE
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. Q
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
'
_$
URINAL
SO. FT. a
FINAL INSRICn
A ING �-��
y
ESTIMATED CONSTRUCTION VALUATION $
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(AUTONDISHI
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, 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 a' 1+i4 c
SEWAGE DISPOSAL
SO.FT.GAR @ IVc
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE k.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ^�/ ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING W
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE _ C�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. NF/r_
I
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIF.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
'
_$
LUMBER GR.
FINAL INSRICn
A ING �-��
y
FINAL INSP.
A60 FING y
/.�
/
REMARKS:
VENTILATION��—
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
E ALL 2�?
J
THING 2 Z
ME H
ULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
,
GARDEN WALL FINAL
city of LaQu*inta
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA
(760) 777-7012 [FAX] (760) 777-7011
INSPECTION RECORD
Permit # 9808-002
STRUCTURAL RETROFIT OF UNIT
ADDRESS
DATE
INSPECTION
[YES/NO]
FRAMING/HARDWARE
PLAN TYPE: ,3
Jl— — 9S
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING
DRYWALL
/2 - //- 98
JOB FINAL
D!1 ,d • �
COMMENTS/NOTES:
S�o�lE 444RIV 6110�e,4o,61
MAILING ADDRESS - P.O. BOX 1504. LA QUINTA, CALLIFORNIA 92253