06321 (SFD)Building
Address 48-210 CaUe Floristas
Owner
Abe is Thelma Grossman
Mailing
Address 9010 Corbin AVe. a 6_3
City Zip
Northridge 191234
Contractor As.- t`z G•� t- Al"'. !4 • r
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
ei.
818-349-3894
f+,Ar '—,
Address
re r „ ,
,77-200 Mi nota
city:,t y ;% A .0 s:1 I Zip �''? t= 1 j. Tel..
State Lic. City _
& Classif. � 3� Lic. # /
Arch., Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTORS 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
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,8useress 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 ft a signed statement that he is licensed pursuantto
the provisions of the Contractors 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 vitiation 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, Suisness and
Professions Code: The Contractors License Law does not'apply to an owner of property who
builds or 'reproves thereon and who does such work himsell 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.)
O 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 Contractors License Law.)
❑ 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 thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. D Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be cavnpleted 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: 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 provisions or this permit shall be deemed revoked.
11
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, CM 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 car tity 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
No. 06321
11LDING: TYPE CONST: OCC: GRP. -
P. Number .. 617-+632-029~.: .
Legal Description
H f
Project Description Tract 20632-2, Plan 5R, %t 29
Sq. Ft. 2} No. No. Dw.
Size Stories Units.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $103,,143
PERMIT AMOUNT
Plan Chk. Dep. '
Plan Chk. Bal. $ 548.10
Const. 633.50
Mech. 66.30
Plumbing 144.30
S.M.I. 7.26
Grading
Driveway Enc.
Infrastructure 2,320.76
TOTAL
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 DATEI��FE� OR
9
Issued by: Date 33..99 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS01
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
——�
w
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 V c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
MESH
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS01
AE WER OR K
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
ZgXAS (ROUGH)/— �'
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$
=$
GR,
FINALINSP.3-;�2— 9V
SLUMBER
LFRAMING —
�Yl/C/F^OOFING
66INAL INSP. —7 ':2q—r/
——�
w
19.t'/✓�C`jf
/ , 1 Q �/$
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
//GE'AR.
`(LATHING
MESH
U,(NSULATION/SOUND
v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL