06320 (SATT)414 a"
J P.O. BOX 1504
No. 06320
Building 78-105 CALLE ESTADO
Address 48-208 Calle Floriotae LA QUINTA, CALIFORNIA 92253
Owner
Abe & ' lm Grosamm BUILDING: -TYPE CONST., OCC: GRP.
Mailin
Address 9010 Corbin Ave.. S-3 617-x652-028
•� - � A.P: Number
City Zip Tel.
Northridge 91324 .818-.349-5894 Legal Description
Contractor jf f v f ,? / '''- !� .` Project Description Tract 20652•'2 * PIS 5R, Lot 28
Address: �'?� -at•71�✓'t�r).. / -
71400- M�esca—
Cityar'Va1:m De$ert ZI e
x2260 T
, 345-5430 ,
State Lic. f �, c," ` 7City' � -
& Classif.- 333- Lic. # � � Sq. Ft. 2001 No. No. Dw.
Arch., Engr., Size - Stories Units -
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 Estimated Valuation $103 145
1 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 pemnft to foe a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 appficant for a permit Plan Chk. Dep.
subjects the applicant to a c" penally of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $ 548.10
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. b53 5Q
Professions Code: The Contractor's License Law does not apply to an owner of property who •
builds ornrnproves thereon and who does such work himself or through his own employees, Mech. >5j�j ��
provided that such improvements are not intended or offered for safe. ft, however, the building. ding t •
or improvement is sold within one year of completion, the owner-buider will have the burden Electrical 112
of proving Nat he did not build or improve for the purpose of sale.) •
36
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 144.50
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for S.M.I. 7.28
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date - Owner �� Infrastructure 2,320.716
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL r � �•- ��r •-- ,•` , C +� a
i r .
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, 1 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: ff, 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 provisbrns 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 thi 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
REMARKS
�.n*:a�� �,� ts�rt:Q ftk-•�:-.spa se
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—' I� §7C�T�,OR
Issued by: Date + ! Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEWER OR
ROUGH WIRING
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)/
r V CJ
DRAINAGE PIPING
CAR P. SQ. FT.
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ryr
FINAL INSP�'-v<'�2v
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�OOFING /� �'—
LAUNDRY TRAY
AIR HANDLING UNIT CFM
0 /J/ f
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. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 ��'
AGROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
HEWER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)/
r V CJ
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 x$
=$
LUMBER GR.
ryr
FINAL INSP�'-v<'�2v
RAMING � �
INAL INSP.
�OOFING /� �'—
G✓ J
; r r
0 /J/ f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATIONISOUND
FINISH GRADING
I
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL