05257 (SFD)Ti44*4a"
P.O. BOX 1504 No.
Building 7&105 CALLE ESTADO
Address 48-10 Via HeP'D1oaa LAQUINTA,CALIFORNIA92253
Abe & Thelma Grossman
Mailing
Address9010 Co Age— S t 3
City Zip Tel.
Frff.-rr'h—r4a 0,& 1 Qi%9At 111 R-1-A'a R, QA
Address
77-200 Minnesota
Zip I Tel.: e r
& Classif• 195333 I Lic. #
Arch., Engr., '
Designer
Address, Tel.
City(Zip I
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
• effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031-5,6ashess and Professions Code: Any city or county which reQuires a
_ permit to construct, attar, irprove, dernofish, or repair any structure, prior to its issuance also
reWdres the applicant for such Penn@ to We a'signed statement that he is licensed pursuant to
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 applicant for a permit
subjects the applicant to a civi penalty of not more than five hundred dollars ($500).
❑ 1, 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 Contractees 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 krprovements are riot intended or offered for.sale. If, however, the building
Of improvement is sold wdkh one year of completion. the owner -builder will have the burden
of proving that he did not Wald 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 projects with a contrac(ors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. Dt P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION '
I hereby affirm that 1 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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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
NOTDCE TO APPLICAKf_ B, after making this Certificate of Exemption you should become
subject to the Workers' Coripeasation provisions of the Labor Code, you must forthwith
Comply with such provsions; or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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 1 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
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number Fa I7•►s�yGO—#?3I
Legal Description
Project Description 'Plan AAs T_etr 'AV
0557
ZONE:
BY:
Sq. Ft. 2562
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Rear,Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback om,Propelty, Line
FINAL DATE
INSPECTOR
12/30/88
Estimated Valuation
Date Permit
PERMIT
AMOUNT
Plan Chk. Dep.
Validation:
Plan Chk. Bal.
, 319.16
Const.
382.00
Mech.
36.00
Electrical
66 i, 10
Plumbing
82.00.
S.M.I.
5.78
Grading
Driveway.Enc.
Infrastructure
1,848.24
F -n .Q-- qP.d
tizadd 131.06
4
TOTAL
S2 870.34 7_71-7
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 om,Propelty, Line
FINAL DATE
INSPECTOR
12/30/88
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
LAB GRADE�(�
ROU PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
WER OR
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
EMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR. FINAL INSP. Gr
ESTIMATED CONSTRUCTION VALUATION $
ROOFING t lt'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (�
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
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 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
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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
OLIND PLUMBING /LFf 7
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE�(�
ROU PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
EMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. FINAL INSP. Gr
FRAMING FINAL INSP.
40
ROOFING t lt'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (�
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
Q
I�
y
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL