04267 (SATT)" 04267
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 78--407 T -'rra Cotta Me LA.QU_INTA,. CALIFORNIA 92253,
Owner
Boulinvard Development
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address 777 S. Main St,. $Mita 106 A.P. Number 613-790-002
City Zip Tel. � .. ....... .. � .�.
clrgel 92686 '0114t�47- 3j,0$0 Legal DescriptionF . A
Contractor , Project Description r ••*
Address Same, Palm Royale - Plan 3 Building 13
City Zip Tel.
City 7-T
State Lic.
City
& Classf.. ' 4 62814 ..
Lic. # _ ,...., r Sq. Ftp �b�g No. «e• No. Dw.:,O'
Size Stories Units
Arch:, Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.thal I am licensed under provisions of Chapter (commencing with Section
7000) of Division,3 of,the Business and Professions Code, and my license is in full force and
effect. '� !
SIGNATURE`_~^'.a ��? '+:•. ' DATE
OWNER -BUILDER DECLARATION J Estimated Valuation .R
I hereby affirm that I am exempt from the Contractor's License Law for the following y+5:
reason: (Sec. 7031.5,Susiness 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 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 that he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penally of not more than five hundred dollars (5500). Plan Chk. BBI. y' a "Y "b'
❑ 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.
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. J -S a uu
provided that such Improvements are not intended or offered for sale. If, however, the building Y�
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical .• 4=
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 a uvi
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 confractor(s) licensed pursuant tothe Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure far • fit
age *b ILI
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. O Certified copy is hereby furnished.
TOTAL
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 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 Minimum Setback Distances:
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, Clvil.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
r
expiration if work thereunder is suspended for 180 days.
ra
1 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
tSl FL'' SO FT rp S
UNITS
A.C. UNIT
COLL. AREA
WWAS GRADE Z _
YARD SPKLR SYSTEM
2ND FL SO FT. C
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR SO FTof
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR SO. FT. QF
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO FT. a
GAS (FINAL)
TEMP. POLE
WALL SO. FT. (U
DRINKING FOUNTAIN
GROUT
URINAL
SO. FT. (a
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
CU. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
41
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
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1V. c
SEWAGE DISPOSAL
SO.FT.GAR rg 3/.c
HOUSE SEWER
MESH
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
UND PLUMBING
,.�� UNDERGROUND
A.C. UNIT
COLL. AREA
WWAS GRADE Z _
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
ZOUND. REINF Z �
l _ ri`75
METER LOOP
HEATING (FINAL)
OTHER APP(EOUIP.
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.
FRAMING Z�
v
FINAL INSP.
ROOFING
.//�
�
V
C
41
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G
MESH
INSU TIONISOUND.'!�:f
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
,
GARDEN WALL FINAL