04195 (SATT)P.O. BOX 1504
Building .. 78=105 CALLE ESTADO
Address 78 423 Terra Cotter LA,QUINTA, CALIFORNIA 92253 w
Owner .u.
Boulevard Develonment BUILDING -T. YPE CONST: OCC. GRP.
Mailing
Address 777 '1Ss tIAIA St -a .$UitO W06, .. . _. A.P. Number, 613-790-002
City Zip Tel.,
or, ange 92686 714-2.4 Legal Description
Contractor Project Description ftWin- CL 14, Plan 2
a �liliE: ,
,• Address
City Zip Tel. .
State Lic. City
&'Classif. 4628i4 Lic. # Sq. Ft.,, 912 No. No. Duv.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition .❑
Address Tel.
Garacre LnClUdeid
City. Zip State
Lic. # 4..
;� -LICENSED. CONTRACTOR'S DECLARATION
I herebyy" affirm ttiat'I am licensed under provisions of Chapter 9 (commencing with Section
70002
of Divlsiori 3 of'the Business and Professions Code, and my license is in full force and
SIGNATURE - ra'r"%DATE "
`. OWNER -BUILDER DECLARATION,
I herebyf-affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 865 a 225
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 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 Plan 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
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. M
Professions Code: The Contractor's License Law does not apply to an owner of property who �3 q
builds or improves thereon and who does such work himself or through his own employees, Mech. w45 • Ou '
.provided that such Improvements are not intended or offered for sale. If, however, the building p �•
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 44 y Yy- •-
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 '15 I.y 00 _
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. - .4 *59 '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) . -
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc: .;
Date ' Owner Infrastructure • 10467.57
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. O Certified copy.is hereby furnished.
TOTAL y �7 l . i ._ �V 3 ., 1 i'
CERTIFICATE OF EXEMPTION FROM REMARKS a
WORKERS' COMPENSATION INSURANCE t ♦1Qa g� +r t '
(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 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.
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 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.) $Iris Setback from Property Line
Lender's Name A '
Lender's Address ' FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to . p `HF
expiration if work thereunder is suspended for 180 days. / POO
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 j
Mailing Address Validation:
City, State: Zip
WHITE FINANCE PINK - APPLICANT, GREEN'- BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE ��
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO F1 rp S
UNITS
HEATING (ROUGH)
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING"
YARD SPKLR SYSTEM
2ND FL SO FT. a
GAS (ROUGH) METER LOOP
HEATING (FINAL)
REINF. STEEL
MOBILEHOME SVC,
BAR SINK
POR SO FT a
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ro
FINAL INSP.
MING .�,
FINAL INSP.
ROOFING
DRAINAGE PIPING
CAR P. SO, FT. g
VENTILATION
FIRE ZONE ROOFING
DRINKING FOUNTAIN
WALL SO. FT. (d
SPARK ARRESTOR
URINAL
SO. FT. Id
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
WASH ER(AUTOKDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
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% c
SEWAGE DISPOSAL
SO.FT.GAR Cd 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE I L.CK.F:EE
CONST. FEE ELECT. FEE
SMIFEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR CONb. SOLAR
SETBACK
e G,_11OUND PLUM BIN UNDERGROUND
A.C. UNIT
GB GRADEtZ ZZ ��6L7
ROUGH PLUMB BONDING
HEATING (ROUGH)
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING"
DUCT WORK
OUND. REINF./?
GAS (ROUGH) METER LOOP
HEATING (FINAL)
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
LU ER GR.
FINAL INSP.
MING .�,
FINAL INSP.
ROOFING
7/ //�
I I / 4
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
M
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
COLL. AREA
STORAGE TANK
ROCKSTORAGE
OTHER APP.IEOUIP.