05240 (SFD)T a 4bf 4 4a�rw
Building 48
-109 Via Hermosa
Address
Owner
Abe & Velma Grossman
Mailing
Address 9010 Corb it
City Zip
Contractor
17-200 Minnesota
City
State Lic. I City
& Classif: 1 Lic. #
Arch.,'Engr.,
Designer
P.O. BOX 1504
78-105 CALLE ESTADO
..LA QUINTA, CALIFORNIA 92253
No. 05240
BUILDING:' TYPE CONST. OCC: GRP. -
3 A.P. Number. X61 i -b 1s�3-�19
-543 Legal Description
Project Description VIn" i A n T.nnt- 17
Sq. Ft.
Size 1950
New ❑ Add ❑
-No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
City
Zip
State
Side Setback from Property Line
Lic. #
INSPECTOR
LICENSED CONTRACTOR'S DECLARATION
Issued by:
Date Permit
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with'Section
7000) of Division 3 of the Business Professions Cde
ro; and my license is in full"+fogrce•and3..
effect.-_ �x.•
:s. r.4 ^ A_
r
-SIGNATQREh s".'' 'w." w a.w. •+'Y.•'�^ _ �e r
11 OWNER -BUILDER DECLARATION f °
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation
reason:- Sec. 7031.5,Business and Professions Code: An or coun which r
( Y city County squires a
$100.128
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ire a signed statement that he is licensed pursuant to
-
PERMIT
AMOUNT
the provisions of the Contractors License taw, 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 Any. Section 7031.5 by 'any
Plan Chk. Dep.
exemption. violation of applicant for a permit
subjects the applicant to a civil penalty of not more than two hundred dollars ($500).
1, 1,
$ 3-63.66
Plan Chk. Bal.
11 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
Const.
�i 35..80
Professions Code: The Contractor's License Law does not apply to an owner of property who
With; or imp vas thereon and who does such work himself or through his own employees,
Mech.
� 00
provided that such improvements are not intended or offered for sale. d, however, the building
.-
• or irnprovement is sold within one year of completion, the owner -builder will have the burden
Electrical
79.86
of proving that he did not build or improve for the purpose of sate.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo-
Plumbing
94
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
..00
does not apply to an owner or property who builds or improves thereon, and who contracts for
S.M.I.
7.,04 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. R. & P.C. for this reason
_
Driveway Enc
Date Owner
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. .❑ 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 thg 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: It, after making this Certificate or 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 '
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Cid Code.)
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is cored.
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
Infrastructure . 2,270.88
Prinee-To d Lidar€1" 131.06
v
TOTAL $3,418.20
REMARKS
k314k;'t.St� S6'a ,ia5t�! irE•�,it,t},r_C;�. IS�"3
t,_Wi l I : ftrri.. :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
INSPECTOR
12/30/88
Issued by:
Date Permit
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
I
SLAB GRADE 3-2—
ROUGH PLUMB,
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT. Q
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
ACK
OUND PLUMBIN94-6155
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 3-2—
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (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$
_$
LUMBER GR.FINAL INSP. .,6FICI
FRAMING p ( FINAL INSP.
ROOFING i�4/z
VENTILATION I
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 6
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
REMARKS:
_ _INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL