04156 (SATT)P.O. BOX 1504 ,
.Building78-105-CALLE ESTADO } i'
Address • 78-415 Terra COifta Ct • 'LA QUINTA, CALIFORNIA 92253 b • ` } -
Owner
Boulevard Development BUILDING: -TYPE CONST. OCC. GRP.
' Mailing *'
Address ' 777 S: 'MaiXlS:3ft.. A iter 106
A.P. Number 4513-�790 '002
City F92686
ip Tel. - _ . ► _ . -
Orange 714-547--0056 Legal Description
Contractor - Project Description Building 14 • Plan 1'
Std
Address
City Zip Tel.
State Lic. City
& Classif. 462014 Lic. # , Sq. Ft. No. No. Dw. ;
Size Stories Units -
Arch., Engr., •
Designer New ❑ Add ❑ Atter ❑ Repair ❑ Demolition ❑
Address Tel.
• City
Zip
State
N '
Lic. #
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LICENSED CONTRACTOR'S DECLARATION
�`-c%;
I hereby affirm•thafl am -licensed under 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 r' ='' F. /4 '.
SIGNATURE - - DATE.
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
,
- 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
- :F
",-AMOUNT '
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 30 IF the Business and Professions Code, or that. he is exempt therefrom, and the basis
for Any Section 7031.5 by 'any for
Plan Chk. Dep.
- •
the alleged exemption. violation of applicant a permit
.,
- •
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
Plan Chk. Bal.
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❑ I, as owner of the property, or my employees with wages as their sole compensation, will
r ,i
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
COr1St.
! U��
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.
�(i � €icy
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
€l �1
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
_ 7I
p 5 y 00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does to builds improves thereon, for
S.M.I.
ti�► -
not apply an owner of property who or and who contracts
such projects with a contractor(s) licensed pursuant to the, Contractor's License Law.)
••
Grading
t; _
'
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
I t bQI a 45
JU
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.
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
•'- ` t �2w � 1 3 Rat '-,t"'
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.
O
,NOTICE TO APPLICANTrIf, after making this Certificate of Exemption you should become
ZONE:
BY:
• subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Distances: '
comply with such provisions or this permit shall be deemed revoked. r
Minimum Setback - "
Front Setback from Center Line
Rear Setback from Rear Prop. Line,
coNsrRucnoN LENDING ACENcrSide
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
1Sa c�
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—
ate
Mailing
Mailing Address
Validation:
• City, State, Zip
GOLDENROD - ASSESSOR'S OFFICE, HARD COP - FILE
-
WHITE - FINANCE,'PINK - APPLICANT, GREEN - BUILDING,
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. _ .. .. _ _ ♦ . . . ! . a l �.. - .. : • a
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p S
UNITS
A.C. UNIT
COLL. AREA
--q40
AB GRADE �y-�
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
MOBILEHOME SVC.'BAR
SINK
POR SO FT of
ROUGH WIRING
OUTLET
ROOF DRAINS
GAR SO. FT. toPOWER
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CARP. SO FT. iC
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN
WALL SO. FT. (d
GROUT
WATER HEATER
SERVICE
URINAL
SO. FT. V3
FINAL INSP. '
ESTIMATED CONSTRUCTION VALUATION S
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
$—Plus—X$—=$
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOXDISH)
APPLIANCE DRYER
ROOFING
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ t V: c
SEWAGE DISPOSAL
Wt)LATHING
SO.FT.GAR ra 3/4c
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
I
D PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
--q40
AB GRADE �y-�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF. 2 G 7 �c—cJ
V
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
$—Plus—X$—=$
GRADING
cu. yd.
LUMBER GR.
FINAL INSP.
NG ��
FINAL INSP.
ROOFING
�
1 ` /V A �
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
Wt)LATHING
MESH
C
NSULATIONISOUND3� 7
I
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL'
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL