05253 (SFD)T4tyl 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 48-132 Via Hermosa LA QUINTA, CALIFORNIA 92253
Abe 6 -Thelma Grossman
Mailing
Address Q KI TO 4: I A ` vas A&,f
City Zip Tel-
13n:-ti�hir itl.nas Q1'• 9A
Contractor
Address 7----
77-200 Minnesota �.
City Zip Tel.:
State Lic. I City
& Classif. Lic. #
10 5 3- 3
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
7000)'6.1 Division 3 of the Business saand Professions Code, and my license is in full rre,an
UGNATUR '"'"""�„' ..* x..-� yw„ 7 y as �+/ le DATE
i OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031-5.0usihess and Professions Code: Any city or county which requires a
pemrit to construct, after, irprove, demolish; or repair any structure, prior to its issuance also
requires the appbcant for such permit to Me 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 civilpenally of not more than five hundred dollars (5500).
❑ 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
Plrolessions Code: The Contractors License Law does not apply to an owner of property who
builds or reproves thereon and who does such work hunself or through his own employees,
provided Mat such nprovements are not intended or offered for sale. If, however, the building
or krprovement is sold wdhrh one year of completion, the owner -budder will have the burden
of proving that he did not build or rrprove 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 appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ a_ & P.C. for this reason c
Date Owner
t
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 Cornpany
❑ Copy is filed with the city. ❑ Certified copy is hereby.fumished.
CERTIFICATE OF EXEMPTION FROM
WORKED' 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 the work for which this permit is issued, I shall not
employ any penton in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, 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 provsons 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
Lenders 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 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, in
No. 45253
BUILDING: -TYPE CONST. OCC: GRP.
A.P. Number �ht 2=�t=rf2�s
LegalDescriptionL� PUNA IJP L f�Z
Project Description at'.. , A a
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REMARKS RR" r!11 I
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ZONE:
BY:
Sq. Ft.
Size ., 1562
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
12/30/08
Estimated Valuation
$8A. 143
PERMIT
AMOUNT
Plan Chk. Dep.
Validation:
Plan Chk. Bal.
319.16
Const.
382.00
Mech.
I .
Electrical
Plumbing
S.M.I.
5- 7A
Grading
Driveway Enc.
Infrastructure
1,94-8.24
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REMARKS RR" r!11 I
t.5;°e
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
12/30/08
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
B GRADE 3
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL) di -4
TEMP. POLE
WALL SO. FT. ®
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.000L 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
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
ND PLUMBING l2
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE 3
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE5r
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH) 10
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) di -4
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR. FINAL INSP. O r
FRAMING NAL INSP. % `
ROOFING-/ t'?
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND Z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL