04191A
TA
P.O. BOX 1504
Buildin78-105 CALLE ESTADO
Address
78-405 Terrel 00tita Cto� _Q
LAUINTA,CALIFORNIA9.2253
g
Owner
zoulevard Development
q_ailing,
Address
777 S, in St. aUita,
City Zip Tel_
1. Orange 1 1 92696 UA
Contractor
L06
41-
-547-805
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 613-7%0-002
Legal Description
Project Description BuUdincr 23, Plan. 2
Sq. Ft. 912 No. No. D w
Size Stories Units.
New 0 Add 0 Alter 0 Repair 0 Demolition 0
Garage included
City
City
Zip
Tel.
..State. Lic.
& Classif. 4628 14
City
Lic. #
Arch:; Engr.,
Designer
Address
Tel.
L06
41-
-547-805
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 613-7%0-002
Legal Description
Project Description BuUdincr 23, Plan. 2
Sq. Ft. 912 No. No. D w
Size Stories Units.
New 0 Add 0 Alter 0 Repair 0 Demolition 0
Garage included
City
Zip
State
,S
Lic. #,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,I am licensed under provisions of Chapter 9 (commencing with Section
7000) Of Divlsion3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE ,.DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation
$651,225
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
for to file that he. is licensed to
PERMIT
AMOUNT
requires the -applicant such permit a signed statement pursuant
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
'any for
Plan Chk. Dep.
for the alleged exemption. Any violation of Section 7031.5 by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)
Plan Chk. Bal.
0 -275A) I
0 1, 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.
331.00
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 o ifered for sale. If, however, the building
'
or improvement is sold within one year of completion, the owner -builder will have the burden'
m
Electrical
44.76
of proving that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
75.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
4459
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
'0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Eric.
Infrastructure
1'#467.3.7
Date Owner
Frinae-Tood
Li card 38.18'
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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
5, Z �1 7 Z 1 1, -J I
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp 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
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 UCTION 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
6/6u/88.
expiration It work thereunder is suspended for 180 days. 1
I certify. that I have read this application and state that the above information I 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 enter the above-
'to,
mentioned property for inspection purposes.
,• Validated by:
Signature of applicani Date
Mailing Address
Validation:
City, State,* Zip
WHITE FINANCE, PINK APPLICANT, GREEN- BUILDING, GOLDENROD -ASSESSOR'S OFFICE, HARD COPY- FILE
r..L
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO F1 Ip S
UNITS
RADE/Z -/��
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. g
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. 0
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ry
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 6
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. a
_$
L MBER GR.
FINAL INSP.
URINAL
SO. FT. (d
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to De 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
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 1 V: c
SEWAGE DISPOSAL
SO.FT.GAR re 3V:c
HOUSE SEWER
FENCE FINAL
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
GROUND PLUMBINGL
UNDERGROUND
A.C. UNIT
COLL. AREA
RADE/Z -/��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
REINF. --g s/
etf-
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$
_$
L MBER GR.
FINAL INSP.
&AMING ��
FINAL INSP.
ROOFING
� /4 n —�
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING .
FIREPLACE
SPARK ARRESTOR'
GA FIREWALL
ING
MESH
TION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL