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05228 (SFD)f I P.O. BOX 1504 W o . 05228 Building 78-105 CALLE ESTADO Address 48-548 Vitt Ainisltad LA QUINTA, CALIFORNIA 92253 Owner .. _..� .. dobe JL Ir-kalaza �ross�tat� Mailing Address City Contractor Address Zip ITel. BUILDING: -TYPE CONST. OCC: GRP. A.P. Number 617-672-042 Legal Description Project Description Paltlrf. 4R. Lcat $7 77-Y200 Minnesota Ave. ' City Zip Tela State Lic. _ City & Classif. 135333 Lic. # Sq. Ft. 1 52 No. No. Dw. Arch., Engr., F 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 Divi§ion 3 of the Business and Professions Code, and my license is in ful iforccee and effect. 1. SIGNATURE_ es':1.,>°.— La ^�,+•r "•.�°'ti's•'�•4>` a'a►. _ .d'et'er DATE ti k OWNER -BUILDER DECLARATION "I. I*ereby, affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a permit to constrict, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rite a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 rive hundred dollars ($500). ❑ 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 Contractors 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.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 fumished. 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. C CONSTRUCTION LENDING AGENCY 1 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 abuilding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I car ity 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 stimated Valuation $82,143 BY: PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. S 69.16 Const.. 382�.00 Mech. 36, 00 Electrical 66, Iii Plumbing r'9 .6i() S.M.I.,. Grading Validation: Driveway Enc. Infrastructure 1 84 8.24• TOTAL $2.739.28 air tS'•.�x' ,t �, REMARKS tr 1 ft6 h, As�� i i�w ,�,� � s0;�„�• .+s ! '�'"1"'+f•KvT, carr �,rx � g� w 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 Issued by: Date12130/8tpermit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRAD=/lip 1 ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. ® FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. ® LUMBER GR. FINAL INSP. URINAL SQ. FT. @ ROOFING v,;Llo ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR' SUSPENDED LAUNDRY TRAY 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. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/.c HOUSE SEWER CERT. OCC. 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 ROUND PLUMBINO� Io UNDERGROUND A.C. UNIT COLL. AREA SLAB GRAD=/lip 1 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL F GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. FRAMING �� FINAL INSP. ROOFING v,;Llo REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL &Z 4b &kit -of Orrr}.-M_ � 1,CM OF Crt f �� ut�� uta t tit ss' P t Caton This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building! Code certifying that at the. time of issuance this structure was in'compliance with the various., ordinances of the City regulating building construction,or use. For the following: BUILDING ADDRESS 48-548 Via Amistad Single Family Dwelling Use Classification —Bldg. Permit, No, 05228 'Group R3 Type Construction VN" Fire Zone Use Zone SR Owner of Building Abe.and Thelma Grossman Address 9010 Corbin Ave., Ste. 3 Northridge, CA �91324 City By. 'Richard Kirkland Date; April 7, 1994 8 ildlng�of �cial Pudding Offi POST INA CON61PICUOUS PLACE -- -------- l i f � �;