05242 (SFD)r � ,
P.O. BOX 1504 No. 05242
Building 7&105 CALLE ESTADO
Address 46-139 Via Hermosa LA QUINTA, CALIFORNIA 92253
- - Abe & Thelma, Grossman
BUILDING: TYPE CONST. -OCC,. GRP.
Mailing
Address Corbin VP Snitiik Z
A.P. Number
7_A4f% ..rbj)1
City
Zip
Tel.
h ' op
19 G
Las3.YS
Legal Description
• - , ,
Project Description
"1 _33 I— I-
Contractor
3ra des CAShma /Sterling Codim.-
Address "
77-200
City
Zip
Tel.'
Palm Desert
922.60
34x5-5430
State Lic.
City
& Classif. 193333
Lic. #
Sq. Ft.; �
Size.
No. No. Dw.
Stories Units
Arch., Engr.,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Ihereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divis ffection 3 of the Business � d Professions Code, and my license is in full foprce and��
p
_SIGNATURE •.fir .!. «F e. �. _ .�.- .r. .� .. �'v .�.'
OWNER -BUILDER DECLARATION
I hereby affirjn that I'am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busf7ess 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 file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
& sion 3 of the Business and Professions Code, or Mat. he is exempt therefrom, and the basis
for the ageged exemption. Any. violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil 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
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 improves thereon and who does such work himself or through his own employees,
provided Mat such improvements are not intended or offered for sale. If, however, the boding
or improvement is sold within one year of completion, the owner-bulider will have the burden
of proving that he did not build or improve' for the purpose of sale.)
Estimated Valuation
y a� ,L 7
a '
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
OOr1St.
440.
5 '
Mech.
ee�� ��qq
39 ♦ 00
Electrical
82.44 '
Plumbing _
198. € 0
❑ 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 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 —B..& P.C. for this reason
S.M.I.
`
Grading
Driveway Enc.
Date owner
Infrastructure
2.7300M
Fr1nge—Toe-d
tizard. 131.06
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 furnished.
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
_
i�y. L +• w-' yy 1� p 11. rra�yr,�. 4}
Pa1. 6�1 rl 1•'t. "-'`- Ttk :�].... ('A3 "•f'f'•'t". i'6.3.. ..� ... '..s
(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 thg work for which'this permit is issued, I shall not
employ any person m 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
cwmplywith such Prorisios_ or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback frim Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance -of the.
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Line
Side Setback frcm Property Line
Lender's Name
FINAL DATE
NSPECTOR
12/30/88
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.
1 certify that I 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
B GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. 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
BOND BEAM
WATER SYSTEM
URINAL
SQ FT @
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
,A
FRAMING g�47
WATER PIPING
NOTE Not to be used as property tax valuation
A
Q
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
LAUNDRY TRAY
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR @ VAc
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
UND PLUMBING 17UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) �'
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINALINSP.
,A
FRAMING g�47
FINAL INSP.Am Q
ROOFING
A
Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND Q�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL