04292 (MFD5)Building
04292
P.O. BOX 1504
8-065 Cbbalt Drive LA QUINTAC
'CALIFORNIA 92253 _
Owner ,.
Boulevard Development
Mailing
Address 777 S. Main St. v SjUite 106
City Zip Tel.
Orange. 92676 7 -��l�7-8066
Contractor
Same
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number - • - 613-790-000
Legal Description
Project Description Plan 3 - Bta ildinq 17
Aaaress
City Zip Tel.
State Lic. City
& Classif. 462614 Lic. # � Sq. Ftp 763 No. 44, No. Dw.
Arch., Engr.,
Size Stories Units
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.
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) 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 ($500).
❑ 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 1, 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
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.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the 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: It, 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.
I certify that 1 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
"'- _ �+.. � + .w-xi14. • .yi}.Llai
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATECT�OR
17/
Issued by: Date ' Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Estimated Valuation
8�
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
151.
Const.
3 V i . 00
Mech.
:3 3 0 VU
Electrical
41-7U
Plumbing
634,00
S.M.I.
:3 .96
Grading
Driveway Enc.
Infrastructure
t �� •
rr ngn-*J3=
xnx
TOTAL
REMARKS
"'- _ �+.. � + .w-xi14. • .yi}.Llai
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATECT�OR
17/
Issued by: Date ' Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
ELECTRICAL FEES r
r
NO. PLUMBING FEES
INITS
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
IOBILEHOME SVC.
BAR SINK
OWER OUTLET
ROOF DRAINS
HEATING (ROUGH)
DRAINAGE PIPING
FORMS
DRINKING FOUNTAIN
SEWER OR SEPTIC TANK
URINAL
DUCT WORK
WATER PIPING
FOUND. REINF.
FLOOR DRAIN
OUGH)
WATER SOFTENER
IGN
WASHER(AUTONDISHI
REINF. STEEL
GARBAGE DISPOSAL
GAS (FINAL)
LAUNDRYTRAY
KITCHEN SINK
EMP USE PERMIT SVC
WATER CLOSET
OLE, TEMIPERM
LAVATORY`
MPERES SERV ENT
SHOWER
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
1. FT. RESID Iw c
SEWAGE DISPOSAL
SO.FT.GAR V4c
HOUSE SEWER
FRAMING l�h r� ®
l v
GAS PIPING
ERMIT FEE
PERMIT FEE
i
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /iL
OUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
OUGH)
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.
$ plu5 x$
'
= $
LUMBER GR.
FINAL INSP.
FRAMING l�h r� ®
l v
FINAL INSP.
ROOFING
i
REMARKS:
y
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL' INSPECTION
CERL�OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL