06291 (SFD)Tihf 4 �Cl�rw
Building 48-217 Calle lfloriatas
Address
Abe & Thelma GrOtssun
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 9010 Corbin Ave.: S-3
City Zip Tel.
Northridge 1 91324 $18-349•-5894
Contractor r 4- (.
Address / 1 1 f" •- lad
7,Z -,200,.E
City: , :�4 stn a Zip _r: - Tel.
Xalmrt 92JA0, 345,!-500
& Classif. 47 ttSC979 Licy#
Designer
Address
Zip (State
Lic. #
LICENSED CONTRACTOWS DECLARATION
1 herebrm that I am licensed under provisions of Chapter 9 (commencing with Section
effec ofy affi
tension 3 of the Business and Professions Code, and my license is in fullforce and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby 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 construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the appitcant 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
DNision 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 civilpenally of not more than two hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Prblessions Code: The Contractors License Law does not apply to an owner of property who
builds or improves thereon and who doas such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or kmprovement is sold within one year of completion. the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project- (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such proiects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(ibis section need not be completed H the perm is for one hundred dollars ($ t 00) valuation
or less.)
I certify that in the perfom,ance of thg work for which this permit is issued, I shall not
=any person in any manner so as to become subject to the Workers' Compensation
Laws of Cahfomna
Date Owner
NOTICE TO APPLICANT- ff. after making this Certificate of Exemption you should become
sub)ect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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
Lenders Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration it 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
ateMailing Add r--
City, State, Zip
No. 06291
LDING: TYPE CONST. OCC. GRP.:
P. Number bI7-15:��{iil9
gal Description
oject Description Trost 23052-2. F3,*n 3R, Lott 4
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 IMEROR
Issued by: Date_Permit
Permit
Validated by:
Validation:
Sq. Ft. 1980
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$102,226
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
4 • 4 3
Const.
6:)o •v
Mech.
004W
Electrical
11167Z
Plumbing
43
S.M.I.
1021
Grading
Driveway Enc.
Infrastructure•
TOTAL
REMARKS
i�i� `rA�f1�
i i li 1 r1L, ! '�,sj�-', • t:,
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 IMEROR
Issued by: Date_Permit
Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
RTRIWTI IRF DI I IIu1RINr: FI Fr:TRIr.AI HFATINr: R AIR r.nNr1 Rnl AR
SETBACK GROUND PLUMBI UNDERGROUND A.C. UNIT COLL AREA
F 41
SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK
FORMS SEWER ORS IG ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND. REINF. S (ROUGH)/, METER LOOP HEATING (FINAL) OTHER APPJEQUIP.
r 2?4
O_'
�
REINF. STEEL GAS (FINAL) TEMP. POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR.1 INAL INSP) yd.
7�
RAMING FINAL INSP. $ plus x$ _$
REMARKS:
ROOFING
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SOLATION/SOUN4%�2
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
YARD SPKLR SYSTEM
2ND FL SO. FT.
MOBILEHOME SVC.
BAR SINK
POR. SO. Ff. ®
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT. @
WALL SO. FT.
DRINKING FOUNTAIN.
URINAL
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
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(AUTO)(DISH)
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 I-Ip
POLE, TEM/PERM
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 ®1 Va c
SEWAGE DISPOSAL
SO.F7.GAR ®3Yec
HOUSE SEWER
FINAL INSPECTION
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
-� ••
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I