06301 (SFD)4 4 Qu
P.O. BOX 1504
Building 48-225 Calle $1.orista 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
- - Abe & Thelma Grossar�s
Mailing'
Address 9010 Corbin Ave.., S-3
City Zip Tel.
Northridge 91324: $18-349-5894
Contractor J? r
Address
City: ,-- ; ,-? Zip 1. a G Tela
•-Palm-sem- — 922 st} 345-5430
State Lic. 41 a/ G �' City � ti
8 Classif. ----$9511 3•---.._ Lic. # 26
Arch., Engr.,
Designer
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
eff
SIGNATIIgE 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 constnict, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
Me provisions o1 the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
OWsion 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 civilpenalty 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
bums 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.)
❑ 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 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
aliforniaDate 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.
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.)
Lender's Name
Lender's Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. -
I certity 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 Addr��
City, State, Zip
No.
BUILDING: TYPE CONST. OCC: GRP
A.P. Number 617-652-013
Legal Description
06301
Project` Description Tract 20052-2, Plan 1'R, Lot 13
Sq. Ft. 2852 No. No. Dw.
Size • Stories Units A
New ❑ Add ❑ Alter ❑' Repair ❑ Demolition ❑
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
9%13%89
Issued by: Date Permit
Validated by:
Validati
Estimated Valuation
$90,142
PERMIT
AMOUNT
Plan Chk.•Dep.
Plan Chk. Bal.
$ 522.54
Const.
626.00
Mech.
54.00
Electrical
107.28
Plumbing
132.50
S.M.I.
6.79
Grading
Driveway Enc.
Infrastructure
2,163.19
TOTAL
$3,618.30
/i z /" _.:J_ )
REMARKS
A.nd;iAj..l.t'1-1-,r4b.#A-i7-q,
9 _ -- 10
11.1 i.rf#.eif x 7777C rw
a -OVA 7
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
9%13%89
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL AREA
(LAB GRADE .
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
DUCT WORK
ROCK STORAGE
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL) ,
� 6
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
SERVICE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
BOND BEAM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR,
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING _ p1
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, TEM/PERM
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/. c
SEWAGE DISPOSAL
SO.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
SETBACKo ��/b
GROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL AREA
(LAB GRADE .
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR I
NK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)/
_ 610O
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GROUT
GAS (FINAL) ,
� 6
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR,
/1
IN AL INSP..2 �
a�
RAMING % -2 G`
FINAL INSP.
ROOFING _ p1
O�C �U
�� )�_ !� _ B Ot
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
(� INSULATION/SOUND/2- ?�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL