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04220 (MDF5)Qum& 04220 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 78-057 Cobalt Drive LA QUINTA, CALIFORNIA 92253 Owner Boulevard Development BUILDING: TYPE CONST. f OCC. GRP. Mailing Address 777 S. Main St. i $UitO 306 A.P. Number - £13-;790--007 City Zip Tel. Orange 734-'547•- 056 Legal Description Contractor Project Description Building 18, Plan 2 S Address City Zip Tel. State Lic. gG8i4 City 91 & Classif. Lic. # ... Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. ttracre included City I Zip I 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 effecI . /'' - U ^ "?',� . J_L-. SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a permit toconstruct, atter, 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) 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 subjects the applicant to a civil penalty or not more than five hundred dollars ($500). ❑ I, as owner of the properly, 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.) ❑ 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.) O 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner 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.13800, Labor Code.) Policy No. Company " `` .1 / ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM 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, 1 shall not employ any parson 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 subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) Lender's Name 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. 1 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 City, State, zip REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback rom Rear Prop. Line•sr1­44;7— 1 1 Side Street Settiack from Center4`1 from Ji 1 Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date 6/29/88 Permit Validated by: Validation: WHITE - FINANCE, PINK -.APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE Estimated Valuation $655225 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. •� •- Const. I • Mech. • rite Electrical • Plumbing 15 • DO S.M.I. 4 • `J Grading Driveway Enc. Infrastructure r� • �,:AZUr4A 15 TOTAL t 4 J n d l REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback rom Rear Prop. Line•sr1­44;7— 1 1 Side Street Settiack from Center4`1 from Ji 1 Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date 6/29/88 Permit Validated by: Validation: WHITE - FINANCE, PINK -.APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE 'NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl rp S UNITS COLL. AREA I SLAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. C HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO F1. at DUCT WORK ROCK STORAGE FOUND. REINF. %�7 /J/ POWER OUTLET ROOF DRAINS GARSO. FT. Iia HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) RAINAGE PIPING D CARP. 50 FT. @ ' GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. Q FINAL INSP. BOND BEAM WATER SYSTEM URINAL SO. FT. 0 GRADING cu. yd. plus x$ _ $ ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING , NOTE: Not to Ix used as property tax valuation ROOFING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.0OOL HOOD SIGN WASH ER(AUTO)(DISH) 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, TEM/PERM 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 14: c SEWAGE DISPOSAL SO.FT.GAR 3/:c HOUSE SEWER GAS PIPING - • ! *i' 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 GOND. ,SOLAR 24_ SETBACK GROUND PLUMBINGUNDERGROUND A.C. UNIT COLL. AREA I SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. %�7 /J/ (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE ' GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _ $ LUMBER GR. FINAL INSP. FRAMING Sn „�%� Y/ .d FINAL INSP. ROOFING CV� 9 2/ V / �'nzo If /� A/l e REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR • GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL