05263 (SFD)f
�IGi�I'I�IGV
P.O. BOX 1504 No. 05263
Building�,. 7&105 CALLE ESTADO
He
Address 48-108 Via rmosa LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Abe Lt[ Thelma Grossman: BUILDING: TYPE CONST. OCC:.GRP.
Address "•'•
€� t} ne•h sr fiv>t4 A.P. Number 1� 7-640-4130
City Zip Tel. _ ... _ . _ ..
ATnrs3as�i rY tra s� '2'Ilr ; Vit.. Q '�g�• gaA Legal Description
Contractor ., Project Description »D't an, 141 � Los. 341
Address • p _.»
77-.200 Minnesota
City Zip ' Tel.:
State Lic. City
& Classif. Lic. # • . Sq. Ft. No. No. Dw.
a _ Size Stories Units
Arch:, Engr.,
Designer. New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address, Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I he affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
70p of 1pvi lion 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affiryn that I am exempt from the Contractor's License Law for the following s. j
reason: (Sec. 7031-5,Busness and Professions Cade: Any city or county which requires a.
04,139
Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also _
requires the applicant for such permit to fde a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section •7000) of
Division 3 of the &ainess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption- Any vfotation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civilpenally of nal more Man five hundred dollars (8500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. w 368.55
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. j4 4150 -
Professions Code: The Cordractors License Law does not apply to an owner or property who 1,
builds or improves theieon and rho does such work himself or through his , own employees, Mech..
Provided that such &Wmveinerts are not intended or offered for sale. If, however, the building 39.00
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical '
of proving that he did not build or irtprove for the purpose of sale.) 75.01
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 86.00
struct the projecL (Sec. 7044, &usimess 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 S.M.I.'
such projects with a cartbactar(s) licensed pursuant to the Contractor's License Law.) f1 • -6 2 .. .
❑ I am exempt under Sec- R- & P.C. for this reason Grading
Driveway Enc.
Date - owner Infrastructure 2.343.43
is a—Tcsed L Izard
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
y ❑ Copy is filed with thecity. ❑ Certified copy is hereby furnished. .
TOTAL $3,494.87 •_{�-/�1!.f _moi
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE [ n C r (yea
(This section need not be completed ff the pemdl is for one hundred_ dollars ($ 100) valuation pyps�,-k,, . -i ,y ! „ka+"` C; •YQ„ „_ o
or'less-) ;#: �. ►tNr1 :4 i U 4 tt;... t :a�r<J't «v,,, t
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
NOTICE TO APPLICANT.- ff, after rnaltimg this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' compensation provisions of the Labor Code, you must forthwith
comply with such provownsorthis Permit shall bedeemed remked. Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CivaCode.) Side Setback from Property Line
Lenders . Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
A
expiration if work thereunder is suspended for 180 days. 12 / 3 6a 1$ Q
I certity that I have read this application and state that the above information is correct. - Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorae representatives -of this city to enter the above-.
mentioned property for inspection purposes- Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
GRADE —
1ST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. SD. FT.
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO FT ®
4
FRAMING c1g.`
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS.
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
INSULATIONISOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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
O PLUMBING J_
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE —
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
Q
EWER OR S
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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.
4
FRAMING c1g.`
FINAL INSP.
ROOFING C�
REMARKS.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ,�i C/L
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t
CITY OF IA WINTA
DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
584-2246
24-HOUR NOTICE FOR INSPECTIONS
Owrwr Grossman
Contractor Cashman/Sterling Com,
Permit Number 5263
POST ON JOB IN, CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 48-108 Via Hermosa
S:F.D. Lo E' 30
TYPE.OF INSPECTION DATE • INap'.
FOUNDATION,& SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE.
DO"NOT POUR CONCRETE UNTILALLAB.OVEliAMENIMM11)
CONCRETE SLAB
JOISTS 8 GIRDERS: F>;�
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING \.
ROUGH GAS 8 GAS TEST
HEATING 8 VENT- NC
FIREPLACE
ROOF
BOND
BEAM-
O.K. TO WRAP t :�
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK .
FI
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C.
HOUSE NUMBERS
JOB COMPLETED
"Mr- rwvvr_n
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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