04190 (SATT).44 .,
P.O. BOX 1504 -
Building78-105 CALLE ESTADO -
Address 781-403 To
a ' a ' • LA QUINTA,,,. LIFORN-IA 92253.
Owner y Boulevard DeVeA ap Mt
BUILDING: TYPE CONSTr OCC. GRP.
Mailing
Address
777-S. Main St. SU1te 106 A.P..Number 613-790-002,
City Zip - Tel.
a orimae 92686 714-- l-805 Legal Description
ContractorProject Description �8Ui'`�lc� �13, Plan 2
Same
Address
City Zip Tel.
State L•ic. City
& Classif. �� Lic. # ,, , , .Sq. Ft. �. 914. No. w No. Dw.': •
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑'
Address. Tel. 1rage included
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.that kam licensedvnder 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.:ewrk.
f
SIGNATURE ''Yr DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following Estimated Valuation $65 * 225
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also
requires the. applicant for such permit to file a signed statementthat he is licensed pursuant to - PERMIT - AMOUNT
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 basin • pian Chk. De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ,
Plan Chk. Bal.
O I, as owner of the property, or my employees with wages as their sole compensation, will a f�
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 331 0.0
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, Mech. 36.00
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.4 .� l
y
• ' of proving that he did not, build or improve for the purpose of sale.) . ,.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 7540
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law ((ii ,
does not apply to an owner of property who builds or improves thereon, and who contracts for S;M,I, 4 *59-
such projects with a contractor(s) licensed pursuant tothe Contractor's License Law.)
•
❑ 1 am exempt under Sec. •'B. & P.C. for this reason Grading'
Driveway Enc.'
Date Owner Infrastructure
, i� /Iw /F.F33��M�utl7rTM� �1 6��� �t1% • {7 - • .
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. ' ��^• �^ '
TOTAL y p aw ,► r m - .t �, .._r f'
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE y� c tlac ,icy aCsa,
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation 4+1}.tSti.rhgt)gs ;#,a
or less.) - -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO 'APPLICANT: 8, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the .Workers' Compensation provisions of the Labor Code, you must forthwith ` Minimum Setback Distances:
• comply with such provisions or this permit shall be deemed revoked. .
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line '
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit, when properly filled out, signed and validated, and is subject to' 9� �� Fy£'s ,
expiration If work thereunder is suspended for 180 days. -
I certify that I have read this'application and state that the above information Is correct. -,Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives. -of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address ' Validation:'
City, State, Zip
• 'WHITE -FINANCE, PINK APPLICANT GREEN -BUILDING, GOLDENROD.- ASSESSOR'S -OFFICE, HARD COPY -FILE
h
dSJ.,.. �'�..:.... ., IS d•..-1 .' .('. a ^ X•. � :.=$'.l _ a ' � k . ?: : .. � i:a. - - .. "�.r. ,. -..__ L- ... .f .: �r'�« ,. . -,.. ., ..... - ..- .. - -..'Aft f:•L .... i. ,. �, : L' .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT W S
UNITS
ROUGH PLUMB
BONDING
-
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR SO FTa
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ra
TEMP. POLE
DRAINAGE PIPING
CARP. SO FT. �
SERVICE
FINAL INSP.
DRINKING FOUNTAIN
WALL SO. FT. /a
GRADING
CU. yd.
$ plus xE
= $
URINAL
SO. FT. !a
ING 3 _
FINAL INSP. T_
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(AUTONDISH)
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
ULATIONISOUND 3r
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR (a 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 & AIR COND. SOLAR
SETBACK
OUND PLUMBINC/Z�Z g UNDERGROUND
A.C. UNIT
COLL. AREA
8 GRADE/ -/6 :�OCI
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
UNO. REINF/g �(�
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 xE
= $
LU BER GR.
FINAL INSP.
ING 3 _
FINAL INSP. T_
ROOFING
JG�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
I G
MESH
-09
ULATIONISOUND 3r
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE:SIINITIALS
GARDEN WALL FINAL