05244 (SFD)4
P.O. BOX 1504 N o . 05244
Building 78-105 CALLE ESTADO
Address 48"133 Via Hermosa LA QUINTA, CALIFORNIA 92253 -
Owner
Abe Velma Grossman
Mailing' BUILDING: TYPE CONST. OCC: GRP.
Address ) A.P. Number ►I7w67ii—{G5
City Zip Tel. r
Le al Descri tion
9 P
Contractor
Project Description P'E AIN 111Is i,nf, 5
AAA
77-20or Minnesota .
City Zip Tel.:
'Palai Desert 92260 .345--•
State Lic. City
& Classif. Lic. # '
1 333
Arch., Engr:,
Designer
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing withSection
7000) of Division 3 of the Business and Professions Code, and my license is -in fulblorce.and
effect
..r' `,l. .rAr.•C:Yii.:-. ,w•�.er.�.�°y �Y-'."-!W.16. w+' .. �'i;f.A. rg�f ! 1 "�
/ RGNATUg_E" ! �.,• d ¢c.- a ea .�`� ,Y DATE
j t OWNER -BUILDER DECLARATION Ir "
�'"• -I hereby affirm 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, after, improve, demolish, or repair any structure, priori to its issuance also
requires the applicant 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 Cade, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any L vk#ation of Section 7031.5 by 'any applicant for a permit
subjects the.applicant to a civilpenalty of not more than Irve 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 Law does not apply to an owner of property who
builds or unproven thereon and who does such work himself or through his own employees,
provided that such 6rprovements are not intended or offered for sale. If, however, the building
orimprovement 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.)
❑ 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 apply to an owner or 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 B. & P.C. for this reason
Date Owner
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, tabor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE 1 '
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of lhF 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: ft, after making this Certificate of Exemption you . should become
subject to the Workers' C.onvensation provisions of the Labor Code, you must forthwith
comply with such Provsiors or this permit shag 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify 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
TOTAL [PV3s469.10
REMARKS
11V L.11.etf r iUi t;4 d 14'4 U51 a4V
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. No.
Size • . w Stories
No. Dw.
Units -
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
12/iota
Issued by:
Date Permit
Estimated Valuation
A
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
440,50
Mech.
sq syn
Electrical
Plumbing
, 00
S.M.I.
7
Grading
Driveway Enc.
Infrastructure
2 .300
4
&
TOTAL [PV3s469.10
REMARKS
11V L.11.etf r iUi t;4 d 14'4 U51 a4V
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center.Line
Rear Setback from Rear Pimp. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
12/iota
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
B RADE�� 7
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
Oe FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE Not to be used as property tax valuation
ROOFING/Z� '
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING !q
MESH
INSULATIONISOUNDS
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
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
LAUNDRY TRAY
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.
SO. 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/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
ND PLUMBINGZ-!
UNDERGROUND
A.C. UNIT
COLL. AREA
B RADE�� 7
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
Oe FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. /,f-
FRAMING FINAL INSP.
ROOFING/Z� '
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING !q
MESH
INSULATIONISOUNDS
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
77
REMARKS:
SIGNATURESIINTTIALS
GARDEN WALL FINAL