04288 (MFD5)04288
P.O. BOX 1504
Building 78-049 Cobalt Drive78-105 CALLE ESTADO
Address . LA QUINTA, CALIFORNIA 92253, ,
Owner M
Boulevard Development _
Mailing
Address 777 S •Hain St • , SUL a 14
BUILDING: TYPE CONST. OCC. GRP.
A.P: Number 633-790--007
City Zip Tel.
t�Zl�tfl+� a 9268 714.547 -$arid
Legal Description
Contractor
Project Description Y
�1 fixi 3, -Ruildirka 18
Address
4
City Zip Tel.
State Lic.
& Classif. 452814
City
Lic. # �.
Sq. Ft. 763
Size
No. , No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
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
effect. • �Jf f�i�. --,77 L.t .•%t �,�✓
P'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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.
subjects the applicant to a civil penalty of not more than five hundred dollars (E500).�
❑ 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
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,
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
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
p C
rG70
PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
1
Const.
•
Mech.
Electrical
X • f
Plumbing
�. ♦ ��
S.M.I.
J •
Grading
Driveway Enc.
Date Owner
Inffryasyt�ructture)
1 19.
Y941_
�y�y■� y ( giy�v, �y
1V 4h�i�6�141a V-i1iM W> NF�-0� Y V V 1 !. -
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 w - .+e.
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
-
TOTAL
$ i� :7•if� �.L.1�..+•f+ J
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuationy-�•-(+tTxl
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.
REMARKS
(� }2 i ♦ t ►c�
_ ......... .. ...
-
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
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
FINAL DATE
Issued by:
_Validated by:
INlS.PCTOR y` r'YCT
88
Date Permit
Lender's Address
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 certify that I have read this application and state that the above information is correct.
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.
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
NO. ELECTRICAL FEES
N0, PLUMBING FEES
UNITS z'
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
FORMS
DRAINAGE PIPING
ROUGH WIRING
DRINKING FOUNTAIN
ROCK STORAGE
URINAL
AS (ROUGH)
WATER PIPING
HEATING (FINAL)
FLOOR DRAIN
REINF. STEEL
WATER SOFTENER
SIGN
WASH ER(AUTONDISHI
GARBAGE DISPOSAL
WATER HEATER
LAUNDRYTRAY
FINAL INSP.
KITCHEN SINK
TEMP USE PERMIT SVC
WATER CLOSET
POLE, TEMIPERM
LAVATORY
AMPERES SERV ENT
SHOWER
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
SO. FT. RESID ( 11A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3i:c
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
AECH.FEE PL.CK.rEE
CONST. FEE AELECT.FEE
SMI FEE PLUMB FEE
ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �J
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
,..�f
FINAL INSP. 7CJ
i
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FRAMING 10 ZS ( oc? Q
7
ROOFING -
REMARKS:
'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR°
GAR. FIREWALL
LATHING iJ W
MESH
INSULATIONISOUND '3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL