04158 (SATT)Building
Address
Owner
Mailing
Address
- City
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P.O. BOX 1504'
�% 78-105 CALLE ESTADO
78w Ferre �'CJtt a LA OUINTA, CALIFORNIA 92253 '
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Boulevard Developmont- - BUILDING: TYPE CONST. OCC. GRP.
777's. Mala St. r Suite 106 A.P. Number 633-790-001
T
ipTel. o.
714"S4-7-8056 Legal Description +
ContractorProject Description lmllu lllg I L I Plein 4
Same w'
Address ;
City ' Zip Tel.
State Lic. City
•• & Classif. Lic. # t Sq: Ft:.
• Arch., Engr., '
Size
Designer
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) of:Di4ision;3:of the Business -and Professions, Code, and my license is in full force and
effect;il��Y �"aSiftG+i�;.,�s. .�� ,✓ 1`` t !. ✓ 7"ti�: �s+>�;..r
SIGNATURE:,, -`7•-•-:y,' `- - -- - DATE
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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,, 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) or
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
No. No. Dw. ;
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Garacre included
Estimated ValuationF36
i -
PERMIT AMOUNT •r
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.2-77
e'
❑ 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
Const.
'� s'i
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,
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tu
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
Electrical
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4
of proving that he did not build or improve for the purpose of sale.)
-
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
s
. 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
S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
••
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure =
•�'1' 0 '
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 furnished.
TOTAL
;;2 i312 avs
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
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' *�i1�'t x7si !•^••97T i i4€ ~fi''•J••1ir�'+Li. f i,
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
ZONE: -
BY:
,• subject to the Workers' Compensation provisions of the Labor Code, you must -forthwith
. comply with such provisions or this permit shall 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-
ine`Lender's
Lender'sName
,
Lender's Address'
FINAL DATE
• This is a building permit when properly filled out, signed and validated, and is subject to.
--INSPECTOR'
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.
; -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
r
• mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
ki'
r
Mailing Address
Validation:
City, State, Zip
• a
c' pit ;ir v �'_• �e3 WHITE FINANCE, PINK ; APPLICANT, GREEN - BUILDING, GOLDENROD ASSESSOR'S OFFICE' HARD COPY, FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 y $
UNITS
SLAB GRADE /?j" — S
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC,
BAR SINK
POR SO FT. at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. �
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. rd
= $
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. fd
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR"
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a IV, c
SEWAGE DISPOSAL
SO.FT.GAR (9 3.c
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 ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
OUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /?j" — S
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF. / 2
[
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.
y —plus—x$
= $
LUMBER GR.
FINAL INSP.
AMING 'Z.. of
C/
FINAL INSP.
ROOFING
/
l
1-71�
\-
REMARKS:
VENTILATION
FIRE ZONE ROOFING/ars
FIREPLACE
SPARK ARRESTOR"
GAR. FIREWALL
RING 2 -
MESH MESH
INSU IONISOUND
V,
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL