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04150 (MFD5)T4ht444�w Address Address 78 -075 Cobalt Drive Owner Boulevard Do Mailing Address 777 S. Main St. City orange z 92686 Contractor P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 _ 1 - i, R� BUILDING:^TYPE CONST. OCC. GRP. suite 106.. A:P-Number-% q llwM-006 Tel. SAM ... . _ _.. Address MK State Lic. 4628 : City & Classif. Lic. # IDesigner Address I Tel. City( Zip ( State I Lic. # i 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. / �ti/ •i ".' r i r .� x1,. c ..1 SIGNATURE ,7 DATE - OWNER -BUILDER DECLARATION I hereby affirm that I an, 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). O 1, 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, '4? provided that such Improvements are not intended or offered for sale. If, however, the building orimprovement 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.) O 1 am exempt under Sec. B. & P.C. for this reason I, : Date -"-'-,k 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 ^�''''-- _rs, I O Copy is filed with the city. O Certified copy is hereby furnished. 04IS0 Legal Description Project Description J 1Uiif inq l7 ► Plan i WORKERS' COMPENSATION INSURANCE " (This section need not be completed If the permit Is for one hundred dollars ($100) valuation f,A T1 P1 Al '1 r'.'f f '? . V► Sq. Ft. 926 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Caura>lcte i; alUded employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner - NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Estimated Valuation _ Distances: comply with such provisions or this permit shall be deemed revoked. PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.' CONSTRUCTION LENDING AGENCY • Const. I hereby affirm that there is a construction lending agency for the performance of the .344 • UU Mech. work for which this permit is issued. (Sec. 3097, Civil Code.) J'O + UU Electrical Lender's Name 4 `) . U 41 Plumbing Lender's Address y • 0U S.M.I. This is a building permit when properly filled out, signed and validated, and is subject to i! Grading expiration it work thereunder is suspended for 180 days. Driveway Enc. 1 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 f JIuu • 0ti, F. ri-ince-weea U., tara Old 610 TOTAL W -41 .4 -15 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE " (This section need not be completed If the permit Is for one hundred dollars ($100) valuation f,A T1 P1 Al '1 r'.'f f '? . V► 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: 11, 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 This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 6/27/8 1 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, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE A.. {{ CONSTRUCTION ESTIMATE 4 NO.ELECTRICAL FEES NO. • PLUMBING FEES IST FL SO FT rp $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SO FT. q HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT. a DUCT WORK ROCK STORAGE FOUND. REINF.7 POWER OUTLET ROOF DRAINS GAR SO. FT. a HEATING (FINAL) OTHER APP.IEQUIP., s ' DRAINAGE PIPING ; CAR P. SO FT. a WALL SO FT @ DRINKING FOUNTAIN FINAL INSP. URINAL SO, FT. 43 WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd.' plus x$ _ $ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING �(') / �/3 �i?� �! FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE -DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED - LAUNDRYTRAY AIR HANDLING UNIT CFM SPARK .ARRESTOR, 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 FINAL INSPECTION SO. FT. ® c WATER HEATER MAX. HEATEROUTPUT• B.T.U. SO. FT. RESID @ IA c SEWAGE DISPOSAL SO.FT.GAR @.J/.c HOUSE SEWER .ti 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 ELECTRICAL HEATING & AIR COND. SOLAR . SETBACK'GROUND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE OUGH PLU HEATING (ROUGH) STORAGE TANK FORMS 00, SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF.7 S (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP., s 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. 6� FRAMING �(') / �/3 �i?� �! FINAL INSP. ROOFING / �/ � / - � ! � � t'✓� � �� x/� 01/ '7/, l6/'/ �/ A ppp��y 5� may//'H ( IV 01-- ^ed �1\ r (1 ! REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE • SPARK .ARRESTOR, r, GAR. FIREWALL LATHING, (y MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. If FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS � T GARDEN WALL FINAL