04218 (MFD5)"
04218
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 70-045 Cobalt Drive LA QUINTA, CALIFORNIA 92253
Owner -
Boulevadd Development "' BUILDING: TYPE CONST. " OCC. GRP.
MailinAddress 777 S• %'fain St., Suite 106 � A.P..Number 613-790-00 LA
City Zip Tel. '
Oranlge 92696 714,-547--8056 Legal Description
Contractor Project Description
s7Rrsta _
Address
City Zip Tel.
State Lic. City
& Classif. 462814 Lic. # _ Sq. Ft. „ 912 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
7r tqe inoluded
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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
SIGNATURE f 1 DATE
OWNER -BUILDER DECLARATION $654425
I 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 rile 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 penalty of not more than five hundred dollars ($500). s� 275.61 e 5 C 1
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. yS i .61
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 o/ property who
builds or improves thereon and who does such work himself or through his own employees, Mech. ' AA
provided that such Improvements are not intended or offered for sale. It, however, the building V 0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 44.76
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 75. 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 1 * 467.57
Trinfie—Toad L zard 38.13
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 v %
0 Copy is filed with the city. ❑ 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 PParson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, 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 DATEINSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to /
expiration if work thereunder is suspended for 180 days. ! I
,913
I certify that I have read this application and state that the above Information is correct. Issued by: Date Permit
1 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 properly 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl Ip $
UNITS s
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SO FT. q
OUGH PLUMB
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT Qr
FORMS
SEWER OR SEPTIC TANK
OUTLET
ROOF DRAINS
GAR SO. FT. aPOWER
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/)
`7
DRAINAGE PIPING
CAR P. SO FT. a
METER LOOP
WALL SO. FT. @
OTHER APP./EOUIP.
DRINKING FOUNTAIN
GAS (FINAL)
URINAL
SO. FT. a .
ESTIMATED CONSTRUCTION VALUATION $
• GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
VENTILATION
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID 1 V. C
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR rg 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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
J
SLAB GRADE`
g�
OUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/)
`7
GAS (ROUGH)
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.
t plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING �(, y��/1C D
FINAL INSP..
ROOFING
n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND wng
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN. WALL FINAL