04154 (MFD5)r
04154
P.O. BOX 1504
Building 78-115 Cobalt Drive 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner • .
Boulevard Development
Mailing
Address 777 S. Main St
City lZip
Contractor
State Lic. City
& Classif. 4612814 1 Lic. #
Designer
Address Tel.
City ,I Zip I State
Lic. #
. BUILDING: TYPE CONST. OCC. GRP
.a
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
effecI
.
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,Susiness 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 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
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.)
❑ 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 the(eof..(Sec.-3800, Labor Code.)
Policy No. Company "'-_ —" r— Ar -,f
❑ Copy is filed with the city. ❑ 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 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
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 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
P. Number 613""790'"'0067
Legal Description
~
ProjectDescription Buil.dina 15, Plast 1
REMARKS
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 INSPECTOR-
6/27/88
NSPyECTOR
6/2 7/88
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK,- APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
Sq. Ft. 926
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Garage included
Estimated Valuation
$66t731
PER, MI�
`-
AMOUNT
Plan Chk.,Dep. --
Plan Chk. Bal.
Y 277.82
Const.
334.00
Mech.
36. 00
Electrical
45.04
Plumbing
75.00
S.M.I.
4.60
Grading
Driveway Enc.
Infrastructure
10501.45
FxintreW'Toed
fir;.aard
.38..5
TOTALZ.12.
REMARKS
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 INSPECTOR-
6/27/88
NSPyECTOR
6/2 7/88
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK,- APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO., ELECTRICAL FEES E•
NO. PLUMBING FEES
$
UNITS t•�.
SLAB GRADE
IST FL SO FT rp
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS _
YARD SPKLR SYSTEM
2ND FL SO FT.
DUCT WORK
ROCK STORAGE
FOUND. REINP.
MOBILEHOME SVC.
BAR SINK
POR SO FT Cr
OTHER APP.IEOUIP.
REINF. STEEL
GAR SO. FT. 0
POWER OUTLET
ROOF DRAINS
.
GROUT
DRAINAGE PIPING:
CAR P. SO FT.
FINAL INSP.
WALL SO. FT. ra
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu.yd.
$ plus
LUMBER GR.
URINAL
SO. FT, fd
FRAMING jD �--'/P�
/ FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
ROOFING
VENTILATION
FIRE ZONE ROOFING��
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING r7/ 0 ( U [
MESH
INSULATION/SOUND "okI
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNr:F FINAI
WATER PIPING
NOTE: Not to be used as property tax valuation
-
FLOOR DRAIN .
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTOXDISH)
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, 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 1'A c
SEWAGE DISPOSAL
SO.FT.GAR ;Ac
HOUSE SEWER
-
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS _
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINP.
AS (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
LUMBER GR.
FINAL INSP.
•G c
FRAMING jD �--'/P�
/ FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING��
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING r7/ 0 ( U [
MESH
INSULATION/SOUND "okI
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNr:F FINAI
/®�/t/U
L /
;y ry.)� �C�r'9 /✓�� /�/�
1-100' //4!/`•' (G
/ cl!/'�f
(/ a
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REMARKS:
p
'INSPECTOR'S SIGN ATURESIINITIALS '
GARDEN WALL FINAL