05232 (SFD)P.O. BOX 1504
Building48-135 � $ Q3SY�tL?SEl 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Abe & Thelma Grossman
Address 9010 Corbin Avenue. Suite -
City Zip Tel.
Ne►r .hr3'cla 91324 ale -34
Contractor
Address
w,, Ane
M �
City - — - Zip __ — -- 7eI:
State Lic. I City
& Classif. Lic. # µ -
Arch., Engr.,
Designer
Address I Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) ofnDivisfon 3 of'the Business and Professions Code, and my license is in full -force and
effect: �, ! 1/ r
SIGNATURE t��.�"',-�c yy.,+.�,-.�y. ,� ._ ...� - ,7J` '-DATE
"^^ OWNER•BUILOER DECLARATION e
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busrress 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 app8cant for such permit to Ne a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Sushmess 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 ani penally of rat more than five hundred dollars ($500).
❑ 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
Professions Code: The Contractor's license Lar does not apply to an owner of property who
builds or reproves thereon and who does such work himself or through his own employees,
provided that such improvements are not kdended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not buil at rmpmve 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 apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractorls) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec R- & 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 -
0. Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpfeted 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_ 9, after ma" this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provmv ms or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lenders Name _
Lenders Address
This is a building permit when properlyfilled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above informationis correct.
i
I agree to comply with all city and county ordinances and state laws relating o 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. 0522
BUILDING:- TYPE CONST. OCC: GRP.
A.P. Number
Legal Description .
Project Description
617-644--004
P Rin is A LIntt
A
Sq. Ft.
.Size 14152
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
9 IA2
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
3 w
Const.
424.00
Mech.
6
Electrical
Plumbing
_
I
S.M.I.
7
Grading
Driveway Enc.
Infrastructure
2. 163.19
TOTAL
REMARKS
�47 -- •_ ••i:w'•r4 0.
� V"9 i'i iw, 1 L l'Slf 3A 4 9 i�
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.�%,s—pIus—x$—=$
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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
SPARK ARRESTOR
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
PLUMBIN�
UNDERGROUND
A.C. UNIT
COLL. AREA
RADE 2 i2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
S
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
�-%S.(FINAL)/
TEMP.POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
LUMBER GR.
FINAL INSP.�%,s—pIus—x$—=$
FRAMING 3�
FINAL INSP.
ROOFING 3 2�/
J/A
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4
MESH
INSULATION/SOUND W -A -p
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL