05237 (SFD)ot
P.O. BOX 1504 N Q . 05237
37
Building 78-105 CALLE ESTADO
Address 43-221 Via Rer> osa LA QUINTA, CALIFORNIA 92253
Owner
Abe & Thelma Grossman �- _
Mailing " BUICDING:'TYPE CONST. OCC: GRP.
Address
401(l Co. hin Ave.. Suite 3 A.P. Number' 617-640-011
City Zip Tel.
Legal Description
ContractorF1lot It
Project Description AII 21±x.
Address
77-200 Hinne.sata .... .. _ . M
City Zip Tel.'.
Palift Desert 92260 345.5430
State Lic. City
& Classif. X33 Lic. # Sq. Ft. I Q No. No. Dw.
Arch., Engr., Size. Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address TeL
City Zip _ State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 herebyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of the Business and Professions,Code, and my license is in full force°end
l c
SIGNATUR �'. / • . A° ✓7 DA,TE
OWNER -BUILDER DECLARATION IVEstimated Valuation
I hereby'Mfirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT '
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 Plan Chk. Dep.
subjects the applicant to a ctW penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 363.86
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 435.80
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, Meeh.��
provided that such improvements are not intended or offered for sale. d, however, the building .
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) Electrical 79.86
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 94.00
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 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 B. 8 P.C. for this reason
Driveway Enc.
Date owner infrastructure 2,:270.88
4 c�a
Lizard 131.06
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 '
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
TOTAL 93.413.2®
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section'need not be completed if the permit is for one hundred dollars (5100) 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
aliforniaDateOwner
NOTICE TO APPLICANT: If, after making this Certificate of 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, 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 certity that I have read this applicationandstate that the above information is correct.
1 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
REMARKS rt p t P d a-9 j3
:qv 1.:00110 A iUit`i" x ..A'*&isx.�i•'
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center, Line
Rear Setback fr• rn 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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
GRADE -��
YARD SPKLR SYSTEM
2ND FL SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL)
WALL SO. FT. ®
DRINKING FOUNTAIN
GROUT
URINAL
SO FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
CU. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® VAc
HOUSE SEWER
INSULATION/SOUND i
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
ND PLUMBIN a
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE -��
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Q
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
/ /
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING t� '�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND i
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
t