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04221 (MFD5)1 4 Building Address ss 78. 459 Cobalt Drive - Owner Boulevard Devel©pr Mailing Address 777 S. main at.. Sty City lZip ITe tractor 4 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA,.CALIFORNIA 9225.3, F, L 0 11LDING: TYPE CONST' OCC. GRP. \ / P. Number Igal Description oject Description 1"R11%4.4 M "co 1 _ Sit Alrll Address City _ Zip Tel. State Lic. City & Classif. 462614 Lic. # Sq. Ft. 912 No. No. Dw. Arch., Engr., Size Stories ' Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. taraga in&luded 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 Divisionnr3 of the Business and Professions Code, and my license is in full force and effect. 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, after,, 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 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 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.) ❑ 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. & 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, cbpy thereof. (Sec. 3800, Labor Code.) -FY Policy No. Company c 1 �.r - J d , ❑ 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, 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: Estimated Valuation $65,225 Distances: PERMIT Minimum AMOUNT Plan Chk. Dep. Front Setback,from Center, Line — Plan Chk. Bal. --5-7-73 . b i Const. CONSTRUCTION LENDING AGENCY J;41 * UU Mech. 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.) J6 . UV Electrical Lender's Name 44.76 Plumbing Lender's Address - S. M.I. This is a building permit when properly filled out, signed and validated, and is subject to w Grading expiration if work thereunder is suspended for 180 days. Driveway Enc. I certify that I have read this application and state that the above information is correct. Issued by: Infrastructure I agree to comply with all city and county ordinances and state laws relating to building l�ass7�Jv construction, and hereby authorize representatives of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: TOTAL aC # W-12. 71 REMARKS WHITE - FINANCE, PNK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE,. i........._..,. ._.'.. ._ ,.«-._. . .- . .•.. ... . . .. . .. , - _... - .... . . _. ... ,-.. _1.. .. .. 7_ 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 Setback Distances: comply with such provisions or this permit shall be deemed revoked. Minimum 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 DATE INSPECTOR E This is a building permit when properly filled out, signed and validated, and is subject to -INSPECTOR6/29788 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 Mailing Address Validation: City, State, Zip WHITE - FINANCE, PNK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE,. i........._..,. ._.'.. ._ ,.«-._. . .- . .•.. ... . . .. . .. , - _... - .... . . _. ... ,-.. _1.. .. .. 7_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES' t NO. PLUMBING FEES A.C. UNIT COLL. AREA SLAB GRADE 7/ [ IST FL SO FT (a $ UNITS HEATING (ROUGH) STORAGE TANK FORMS Y ARD SPKLR SYSTEM 2ND FL SO FT. C DUCT WORK ROCK STORAGE FOUND. REINF. n.../ !/ s MOBILEHOME SVC. BAR SINK POR SO FT. a OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. (Y GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. I SO FT. (V WATER SYSTEM WALL SO. FT. a - DRINKING FOUNTAIN FINAL INSP. •?j FRAMING%( URINAL SO. FT. (a n _ a / /n , _ C, ESTIMATED CONSTRUCTION VALUATION $ " WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT . WALL FLOOR SUSPENDED LAUNDRVTRAY AIR HANDLING UNIT CFM IKITCHEN 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 a. 1I/. c SEWAGE DISPOSAL SO.FT.GAR (� 3:c HOUSE SEWER FENCE FINAL 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 /OCTRICAL . HEATING 8 AIR COND. SOLAR . 1 s / SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 7/ [ PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. n.../ !/ s (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. •?j FRAMING%( �INAL INSP. 04 ii00FING n _ a / /n , _ C, REMARKS: " VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR• GAR. FIREWALL LATHING olw MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL