04278 (MFD5)Building
Address 78-089 Cobalt Drive
Owner
Boulevard o-avalopme
Mailing
Address 777 g, Main St., SU
City Zip Tel.
Contractor
Address
Zip
. to rc mow, vi ay
& Classif. 462814 Lic. #
Arch., Engr.,
Designer
Address Tel.
4
04278
P.O. BOX 1504
78-105 CALLE ESTADO
"`• LA QUINTA, CALIFORNIA 92253
BUILDING: 'TYPE CONST. OCC. GRP.
A.P.,Number 613-790-006
D'3 Legal Description
Project Description 'ix�8 1 3, fold nct V;
CityI Zip I 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, 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 ($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.)
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
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 r''l - ;I/O Copy is filed with the city. O 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 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, 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 it work thereunder is suspended for 180 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
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
REMARKS Y
AVt A tt AAF P4fjTr%e1;,u-t11_1D 15 . 67 1 V
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. � ,�
Size
No. 0
Stories
No. DIN,
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
IISP* CTTO�R
Issued by:
Permit
Date_Permit
Validated by:
Validation:
Estimated Valuation
PERMIT,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.��
Const.
+ *IJV
Mech.
JJ . UV
Electrical
Plumbing
b . UU
S.M.I..
Grading
Driveway Enc.
Infrastructure
t �111 .94
Fr5.nge x,oeu
L. zaira
TOTALd�t1•b
REMARKS Y
AVt A tt AAF P4fjTr%e1;,u-t11_1D 15 . 67 1 V
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 DATE
IISP* CTTO�R
Issued by:
Permit
Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
I r - NO. ELECTRICAL FEES , .
r:...
NO. r t •-t PLUMBING FEES
Y
•"t UNITS
COLL. AREA
IST FL SO FT (a
/y
[ Y
ROUGH PLUMB
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL SO FT. q
SEWER OR SEPTIC TANK
ROUGH WIRING
M OBILEHOME SVC.
ROCK STORAGE
POR SO FT. Qt
S (ROUGH)
GAR SO. FT. iK
POWER OUTLET
ROOF DRAINS ; �� sa ;�`a•:-'
REINF. STEEL
DRAINAGEPIPING.
CAR P. SO FT. 6
CAR
GROUT
DRINKING FOUNTAIN`,' �`• �� •'
WALL SO. FT.
FINAL INSP.
-
URINAL~;.`.:
SO. FT. fd
ESTIMATED CONSTRUCTION VALUATION Y
_
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN',
MECHANICAL FEES
WATERSOFTENER7..,
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHERIAUTONDISHI'; Y?�r
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY'TRAY,_,
AIR HANDLING UNIT CFM
KITCHEN' SINK I' ,'I '
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET"
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY.. .' t
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER '
BOILER B.T.U.
SO. FT. ® c
BATH ;TUB t}" •_
SO. FT. @ c
WATER; HEATER', _
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 144 c
SEWAGE DISPOSAL,
SO.FT.GAR a 4 c
HOUSE SEWER,.
GAS PIPING ,
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.rEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE
PLUMBING If ELECTRICAL
HEATING 8 AIR COND. SOLAR —
SETBACK
ROUND PLUMBING
2- oe7
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7
/y
[ Y
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP:
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
-
BOND BEAM
LUMBER GR.'
FRAMING �� - �••
ROOFING E
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING % &_ !Q/
MESH
INSULATIONISOUND to
FINISH GRADING
FINAL INSPECTIOWll
/,
CERT. OCC. 111111
FENCE FINAL
GARDEN WALL FINAL
I
WATER SYSTEM
,.FINAL INSP. i: q
GRADING
FINAL INSP. fy1j cu. yd.
Y —plus—x$ =Y
REMARKS: