05255 (SFD)v
4
P.O. BOX 1504
Building 48-110 '' is 78-105Heriaasa LA QUINTA CALIFORNIA 92253
Address
Owner ,
Abe & Thelma Grossman
Address 9010 Corbin Ave.. Suite
City Zip Tel.
Contractor
Address -7
City a. � ., . �Ip:GaetaTela .. .
Palm Desert 9226034,-,430
State Lic: City
& Classif. 5333 Lic. #
Arch., Engr.,
Designer
Address I Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby,affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7ffeC of Division 3 of the Bus,iressand,Professions'Code, and my, license is`in.full.forc d
• SIGNATUiiiiY DATE
OWNEWBUILDER DECLARATION
'11hereby-affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031-5,13usomess 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 permit to (He 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 Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemptron. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred donars ($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 appy to an owner of property who
bwAds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for `safe. ff. however, the building
orimprovement is sold within one year. of compfeyon, the owner -burbler wig have the burden
of proving that he did not build or improve for the purpose of safe.)
O 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 appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars (5100) valuation
or less.) -
I certify that in the performance of thV 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. atter makdrg this Certificate of Exemption you should become
subject to the Workers' Compensation proviskus of the labor Code, you must forthwith
comply with such provsiew 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 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
No. 45255
11LDING:•TYPE CONST. OCC: GRP.
P. Number 617-1140-029
Legal Description
Project Description PIstn &s ,l T.nt- %9
TOTAL $2.870.36
REMARKS q
fuiteis`a*.3st'r• :?73`t� i�l�«�S'�,.'�.—�i 'kl�l
3: i?1f „i-=
ZONE: BY:
Minimum Setback Distances:
Front Setback'from'Cente `Line y
Rear Setback from Rear Prop Line
Side Street Setback frorli.Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
12/30/88
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. .�
Size
No.
Stories - -
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑
Demolition ❑
Estimated Valuation
$82,143
PERMIT
AMOUNT.
Plan Chk. Dep.
Plan Chk. Bal.
319.16
Const.
382.00
Mech.
36.00
Electrical
66.10
Plumbing
$2.00
S.M.I.
5.78
Grading
Driveway Enc.
Infrastructure
11
,868,.24
Frizz a -Toad
Lizard .
131.46
TOTAL $2.870.36
REMARKS q
fuiteis`a*.3st'r• :?73`t� i�l�«�S'�,.'�.—�i 'kl�l
3: i?1f „i-=
ZONE: BY:
Minimum Setback Distances:
Front Setback'from'Cente `Line y
Rear Setback from Rear Prop Line
Side Street Setback frorli.Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
12/30/88
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
LAB GRAD E31fo—g
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
ER OR SE
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)�f ,ys.��^�
MP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
MESH
INSULATIONISOUND 1 ��
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
FINAL INSPECTION
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
S ACK
OUND PLUMBING3�y
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRAD E31fo—g
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEE
GAS (FINAL)�f ,ys.��^�
MP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
�y {�
FINAL INSP. `Z G
oel
FRAMING
FINAL INSP.
ROOFING / ®
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
r
LATHING
MESH
INSULATIONISOUND 1 ��
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL