04293 (MFD5)Budding 78--067 Cobalt Drive
rs
Owner
Boulevard 13evelop nt
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA„ CALIFORNIA 92253,
W-
Address 777 So Main St. s Rite •i!
City Zip Tel.
n,Y,A sera a I r, 1 A I 71 A K d'
Contractor
Sam
BUILDING.' TYPE'CONST: OCC. GRP.
5 A.P. Number 613-790-006
0429
Legal Description
Project Description , �ftan 3. AttildiAQ 17
Aaaress
City Zip Tel.
State Lic. City
& Classif. 4628:14 Lic. # Sq. Ft. � 763 No. � 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 of the Business and Professions Code, and my license is in full force and
effect. A-0 ff !
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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 thathe 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).
O 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.)
❑ I 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 copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby'furn!shed.
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 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: If, alter 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 1130 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
t,
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
Estimated Valuation
��6r�a6
PERMIT
7/7EC�T�OR
AMOUNT
Plan Chk. Dep.
Validated by:
Plan Chk. Bal.
Validation:
2510aI
Const.
70 . U0
Mech.
33-00
.Electrical
41.7U
Plumbing
b3000
S.M.I.
Grading
Driveway Enc.
Infrastructure
sx ` •`�
eringe—road
Xto zarCA
JO old
TOTAL
*Z ir til: 0'1
�"; • ! i i
REMARKS
il+►��'��°,':13� i��f,��i df2'�iQ�l�fjltt� . t.7 �.�
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 DATEINS
7/7EC�T�OR
Issued by:
Date Permit
Validated by:
Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN.7 BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES,} „:�
NO. PLUMBING FEES
IST FL SO F1 rp $ r'
UIJITSA
SLAB GRADE 7 x,
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. gr
ROUGH)
METER LOOP
GAR SO. FT. or
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO FT. a
GROUT
WATER HEATER
WALL SO. FT. /d
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT,
-
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING �G
WATER PIPING
NOTE: Not to be used as property tax valuation
j
FLOOR DRAIN
MECHANICAL FEES
REMARKS: '
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE' DRYER
GARBAGE DISPOSAL .
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
MESH'
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ((; 11A c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR I 3/4c
HOUSE SEWER
FINAL'; INSPECTION
GAS PIPING
PERMIT FEE
CERT. OCC.
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBINGQ -
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7 x,
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE '
FOUND.,REINF. f
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./f a �-
FRAMING �G
�
FINAL INSP., C/!
ROOFING
j
REMARKS: '
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH'
INSULATIONISOUND
FINISH GRADING
FINAL'; INSPECTION
CERT. OCC.
FENCE FINAL
r
INSPECTOR'S SIGNATURESIINITIALS
i
GARDEN WALL FINAL