06311 (SFD)Tit -if Qub&
P.O. BOX 1504 N o . 06 311
Building 78-105 CALLE ESTADO
Address 48-2,65 Calle Ploristas LA QUINTA, CALIFORNIA 92253
Owner
Abet At 1%alm Grossman
BUILDING: TYPE CONST.
OCC. GRP.
Mailing
Address 9010 Corbin Ave*: ft2A.P.
Number
617-652-023
City
Zip
Tel.
Northridge
91324
818-349-5894
Legal Description
Project Description
Tract 20052-2, Plan 3R, Lot 23
Contractorr- -
• � ' t
Jam" --C. t'ashrim
Address i V : /4 L
77-216 -MSmesofa '
City- - Zip
Ps3xs.11�sert 19.2260
Tel.
345•- 630
State Lic. .. �' j
& Classif. _195333
City
Lic. # _2
Sq. Ft. 1980
Size
No. No. Dw.
Stories Units
Arch., Engr.,
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
7000) of Division 3 of the Business arta Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 penia to lie a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Pro/essions 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 civil penally of not more than five Modred 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
builds or improves thereon and who does such work himself or through his own employees,
provided that such inprovements are not idrrnded or offered for safe. ff, however, the building
orimprovement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or inprove for the purpose of sale.)
Estimated Valuation
102 ,
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 545.43
(,Or1St.
1��0• ��
Mech.
{j� �O
•
Electrical
f
b 11 • 72
Plumbing
'
144.50
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, mess and Professions Code: The Contractor's License Law
does not apply to an owner of property who bulls or irproves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec B. & P.C- for this reason
S.M.I.
7.21
Grading
Driveway Enc.
Date owner
Infrastructure
2,300.09
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. O Certified copy is hereby fumished.
r
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed d the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any mancer so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, after mailing EMs Certificate of Exemption you should become
subject to the Workers' Conpensatian provskrns of the Labor Code, you must forthwith
comply with such provisions or tlds perrrvl 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, Clivi code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 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 orf this city to enter the above-
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS
10- t.o if 1 t!twj,.
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 DATEPPEGTQR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE w-0
FORMS
2ND FL. SO. FT.
BONDING
ROUGH WIRING
YARD SPKLR SYSTEM
STORAGE TANK
ROCK STORAGE
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
HEATING (FINAIa
OTHER APPJEOUIP.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT.
SERVICE
FINAL INSP.
WALL SO. FT.
BOND BEAM
DRINKING FOUNTAIN
SO FT ®
GRADING
cu. yd.
$ —Plus—X$—=$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
INSP. d57�
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING Z_
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
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, 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 @ 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
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 %S��iC�
LRF
GROUND PLUM BI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE w-0
FORMS
ROUGH PLUMB.
q&WER OR S
BONDING
ROUGH WIRING
HEATING (ROUGH)
DUCT WORK
STORAGE TANK
ROCK STORAGE
FOUND. REINF.AS
(ROUGH f o
METER LOOP
HEATING (FINAIa
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINA r —Td
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
INSP. d57�
RAMING�J ,r j
c
FINAL INSP.
ROOFING Z_
M r
�— It v
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
44THING
MESH
INSULATION/SOUND
FINISH GRADING
I
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
!
GARDEN WALL FINAL
1