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04200 (MFD5)tft'� /� cr('� t44 4200 - P.O. BOX 1504 Building78-081 CL1b4lt DriVe 78-105 CALLE ESTADO AddresL'A QUINTA, CALIFORNIA 92253 _ Owner .". Boulevard Development BUILDING:'TYPE CONST. OCC. GRP. Mailing Address 777 S. Main St., Suite 106 A.P. Number ICI --7��-title CityZip Tel. ©ran4qo 92606714-547, l056 Legal Description Contractor. Project Description ATallA Ti.4 1.4. pip" 91 Address City Zip Tel. State Lic. City & Classif. 462814 Lic. # Sq. Ft.r No. w No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Garacie included 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. w r"" Y `1(� _ '- . 1 -,/ J.: G 4. SIGNATURE _ DATE OWNER -BUILDER DECLARATION Estimated Valuation r r` I hereby affirm that I am exempt from the Contractors License Law for the following $65f 225 . 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 PERMIT AMOUNT 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 Plan Chk. Dep. , subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Bal. O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. � � --- ` 570 1 do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. +�� •� 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, Mech. 36 0 provided that such improvements are not intended or offered for sale. If, however, the building ll�1�q or improvement is sold within one year of completion, the owner -builder will have the burden Electrical \�,' •', +M7'f/ .76 of proving that he did not build or improve for the purpose of sale.) p�r� O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing _75- Q V struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law rc� does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 4. b9 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading O 1 am exempt under Sec. B. & P.C.'for this reason Driveway Enc. Date Owner Infrastructure 1,, •t j 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 O Copy is tiled with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 44!%I'I�•t`i►i4'ifi1��"i�U'�7%'• ri i¢ 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: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. 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 I.N PEC R This is a building permit when properly filled out, signed and validated, and is subject to TPE R expiration it work thereunder is suspended for 180 days. 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 CONSTRUCTION ESTIMATE - NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl rp S UNITS A.C. UNIT COLL. AREA SLAB GRADE (Gr (�i/ YARD SPKLR SYSTEM 2ND FL SO FT. C' BONDING HEATING (ROUGH) POR SO FT at _. MOBILEHOME SVC. BAR SINK GAR SO. FT. Cl POWER OUTLET ROOF DRAINS ROCK STORAGE FOUND. REINF. DRAINAGE PIPING CAR P. SO FT. a METER LOOP WALL SO. FT. (d OTHER APP.IEOUIP. DRINKING FOUNTAIN SO. FT. GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES SERVICE WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED _ $ LAUNDRYTRAY AIR HANDLING UNIT CFM I FRAMING, l� l cr9iy .Q FINAL INSP. (,C' v �-- 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 @ I V. c SEWAGE DISPOSAL SO.FT.GAR @ 2i4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE' PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPLCKE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING _ ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMBING NDERGROUND A.C. UNIT COLL. AREA SLAB GRADE (Gr (�i/ ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK' `FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. �7' (y irmrp ✓! 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. I FRAMING, l� l cr9iy .Q FINAL INSP. (,C' v �-- ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR! GAR. FIREWALL a LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FFNCF FINAI /i""' `' c,21S,O REMARKS: INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL -