05226 (SFD)J� 4
cedituG!'IGrGv
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 413--541 Via Amistad LA QUINTA, CALIFORNIA 92253
- - Abe & Thelma Grossman
Mailing
Address 010 Co bi-i Avg.. Six tt ;
City Zip . Tel.
w„
Contractor
Address
77-200 Hiuuenota, Suite 3
City Zip Tela
Pain Desert 1 92260 34.E-5
State Lic. City
& ClaSSif. s n e ft 0% w 1 LIC. #
Arch., Engr., o
Designer
Address' Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 herebyraffirn that I am licensed under Provisions of Chapter 9 (commencing with Section
7000) yof Division 3 of the Business and Professions Code, and my license is in full force and
M 1
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SIGNATURE DATE
OWNER -BUILDER DECLARATION s
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Businass 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 rive hundred dollars ($500). '
0 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, Suisness 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.)
❑ 1, 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ 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 ($700) 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. ft, 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 pemnit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when property 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
BUILDING: TYPE CONST
No.
OCC: GRP.
052.26
A.P. Number
Legal Description
Project Description VIM" '2A T^9- J A
Sq. Ft.�q34 No. No. Dw.
Size Stories Units.
New ❑ Add ❑ Alter ❑ Repair ❑ :Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
I Q R1
Const.
AAA vi
Mech.
Q At1
Electrical
* A 1
Plumbing
oft nA
S.M.I.
Grading
"
Driveway Enc.
Infrastructure
2,300.09
TOTAL _
$3,337.04
REMARKS
AV
n!1 if r`ru.•7Y 1 Y 4. t Ya`i. r ..w.• a ::
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
12/31/)86
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
i
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. @
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING ��/
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
MESH
SO. FT. ®c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/ic
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
R I PLUMBING
—/��
(
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
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 APPJEOUIP.
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.
FRAMING ��/
FINAL INSP.
ROOFING
/
/A%��/�/,/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 11,174Vg
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
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This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
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Code certifying that at the time of issuance i F ths structure was in compliance with the various
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ordinances of the. City regulating building construction oruse.' For the following:
BUILDING ADDRESS 48-541 Via ,Amistad
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Single Family, Dwelling 05226
Use Classification Bldg. Permit No.
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i Group R3 Type Construction �`1 Fin Zone Use Zone SR
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Abe and Thelma Grossman 9010 Corbin Ave: , ..Ste. 3
Owner of Building Address
;
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Nor
City thridge, CA 91324
Richard Kirkland
By.
I I'
April 7, 1994
Dote;
Building Official -
c POST IN A COUMCUOUS PLACE
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