04183 (GRES)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78 - 365 TPrra ICOtta Ct • LA QUINTA, CALIFORNIA 92253*
'Owner
Boulevard DevelC9ment BUILDING: TYPE,CONST. . OCC. GRP.
Mailing
Address 777 S. MaflaSSt a SUg. 8 1-K., .. _. A.P. Number: 013-790-00
City Zip ITel., W
Orange 326965 714-5 47«$� � Legal Description
Contractor r ... "$��41A4 1� P�
Sam '
Address
-,City
State Lica
& Classif.
Arch., Engr.,
Designer
Address
TZip Tel.
46-2814. L1c #
Tel.
Project Descriptions
t
No.
Stories
Alter ❑
No. Dw:
Units
Repair O � 'Demolition ❑
City
Sq. Ft. 9
Size F r
State
Lic. #
New ❑ Add ❑
Garage ftcl
No.
Stories
Alter ❑
No. Dw:
Units
Repair O � 'Demolition ❑
City
Zip
State
Lic. #
+
LICENSED CONTRACTOR'S DECLARATION
.
A 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. -,,r
SIGNATURE- - -'!-•` DATE.-
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law,foi the following
. • reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a.
permit to construct, alter, 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 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 applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
D
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.)
O 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
Estimated Valuation Cr .g ; I.
t d r 222
_
,
' PERMIT AMOUNT
Plan Chk. Dep.- -
7 C . 6 e . .
Plan Chk. Bal. A% a
$ 275.61-
6�
AV �qi1
9y!
Const. ,y o7 1.6 V V .
331,600.
0j
Mech. - 36.00 .
Electrical 44.7,.
g ,
Plumbing 75.00 '
- _
S.M.I. 4 x.5g '
such projects with a contrac(or(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.' y
Date Owner
Infrastructure-
�rringO." V"d L.:;zard 38.28
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. Cl 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 ($100) valuation
e� „9
TOTAL U2 # 272 b I A t i a �• .� i '�
REMARKS
4,i.ii
:'` arl�'!.$' �A-1.4'�'.lAAl�s i'r77!-YA"S✓. t �. y
P
r �,
Of less.)wr�ce
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.
ZONE: BY` .
Minimum Setback Distances: - -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Date - Owner
NOTICE To APPLICANT: If, after making this Certificate of Exemption you should become
subject to 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
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
Lender's AddressFINAL
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.
I 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-
bovementioned property for inspection purposes. ..
mentioned
IN�Sy• �1•
DATE PECTOR
`AfJ� / .
•.Issued by: Date Permit.
, -
Validated by:
Signature of applicant Date
Mailing'Address
i
Validation:
1
City, State, Zip
GOLDENROD- ASSESSOR'S OFFICE, HARD COPY - FILE`..�3
q
♦- . ,. f __ •s\ .::� . it - c la. °. }... �.' _ a , "• 1: ,...._ a... � .n - - .. ter... ... }.i . t t. -,] •n
WHITE FINANCE, PINK -APPLICANT, GREEN -BUILDING,
,5�'.-}r:✓J _..... !' '�� .,... ... _ - ... ..... All :. t i !G I ti . � . w .�. ,...,+
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT Ip S
UNITS
AB GRADE/?
2ND FL SO FT. q
BONDING
YARD SPKLR SYSTEM
POR SO FT. a
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. a
POWER OUTLET
ROOF DRAINS
CARP. SO FT. fg
GAS (ROUGH)
DRAINAGE PIPING
WALL -SO, FT. ra
- OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO FT tp'
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FINAL INSP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/ c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR (& 3:c
HOUSE SEWER
�Q
NG 7 U
'
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 8 AIR COND. SOLAR
SETBACK
D PLUMBINGf?_'?
UNDERGROUND
A.C. UNIT
COLL. AREA
AB GRADE/?
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
—/
UND. REINF./�� -6 L4
( VVV
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
- OTHER APP.IEOUIP.
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.
MING ��
FINAL INSP.
ROOFING
e--- (X^,1�/
�i/C v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�Q
NG 7 U
MESH
NS LATION/SOUND 2i
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL