06283 (SFD)T4t!t
P.O. BOX 1504 IV
Building 78-105 CALLE ESTADO
Address X-201 Calle f' loristas LA QUINTA, CALIFORNIA 92253
Owner
Abe & Thelma G rossrmaa BUILDING: TYPE CONST. OCC. GRP.
Mailing 9,010 Corbin Ave. S-3 Address h 17-6 52 —`.1 0 ;
A.P. Number
City Zip Tel.
Northr- dge 91314 '$1P-349-5844 Legal Description
Contractor Project Description
Address
city, Zip Tel.
PAIM-,zesert
State Lic. City
8 Classif. Lic. # nA^ Sq. Ft. No. No. Dw.
Arch., Engr.,
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
700pf of ❑ivision 3 of the Business and Professions Cade, and my license is in full force and
efFeCL
NATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason_ [Sec. 7031.5;Buskess and Professions Code: Any City or County wbich requires a
pernit to construct, alter, improve, dernoish. or repair any structure, prier to its issuance also
requires the applicanf fur such pemrrl to hie a sfgred stdorrrent f1mi he is licensed pursuant to PERMIT AMOUNT
the prowna rs of the Contractor's Lk'errse Law, Chapter 9 fcormrleneflrg with Section 700Q] of
Plvtsiwr 3 of the Business and Prolesswrs Code, or Mal -he Is orompt themimm, and rho basis
Air the adoged eramptron. Any violation of Secbnrt 7031.5 by any applicant far a parmir Plan Chk. Dep.
subjects the applicant to a c"penaay of nor more Man five hundred red doffam (E50% Plan Chk. Bal.
iri 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_ f,%C- 7044. Bussness and v
Preles.Joaas Coda: The Contractor's License taw does not apply to an owner of property who COr1St. -•-fir' r't'
builds or improves tharrxm and who obas such work hirrseaff or throvgh his awn employees. Mech. i •.lu
Provided that such rmprovements are not kdanded or offered for sale. ill however, the braiding
or irrprovinnerll is sold wither one year of conptefim. the owner-buaider wiI have the burden Electrical �. �1i . �•'?
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- Plumbing
struct the project. (Sec. 7044, Business end ProlesskJrtS Code-- The Contractor's License Law
does not apply to an owner of property who bids or improves thereon, and who contracts for S. M.I.
such projects with a contraclor(s) licensed pursuant to the Conbactor's License Law.)
Grading
❑ I am exempt under Sec. _ ri. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 2 y 1 c 3. 1'
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, oracertified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the perms is for one hundred dollars ($100) valuation
or less.)
I Certify that in the perfonnancc of tltp work for which this permit is issued, I shall not
employ any person in any manner so se to become subject to the Workers' Compensation
Laws of California.
Date owner
NOTICE TO APPLICANT. 11. ellvr mating this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of fine Labor Code, you must forthwith
comply With such provisions or this permit shag bedeonadrevoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCnON 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
tenders Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days-
$ certify that I have read this app8gtion 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 refaling 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 Add Validation:
City, State, Zip.
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SO. FT. ®
2ND FL. SO. FT.
POR. SQ. FT.
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
E
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
S
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
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES MICRO FEE
APL.CK.FEE
=CONSTFEEi
ELECT. FEE
I
SMI FEE PLUMB. FEE
� �
i
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING/ f
!UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ,1
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
FINER OR S AN
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) / ,�Q�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
§ plus xE
=S
LUMBER GR.
oo
,,,,,�//
WO/ NAL INSP.
FRAMING �"
/� I
AL IN .r %11 6
/" I ///�����V//
TWA❑PING
/�
N
p� /� ®
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
xmHING 1
MESH
SULATIONISOUN0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGHATURESIINITIALS
GARDEN WALL FINAL