05509 (SFD)Tihf
I
P.O. BOX 1504
Building r 78-105 CALLE ESTADO
Address 48-100. Vista Clelo LA QUINTA, CALIFORNIA 92253
Owner
I Abe & Ttelm Grossman
Mailing
Address 30-10 Corbis Ave'. S.3
CityZip Tel.
i �+�ort'hsid J91324 814134-9-5894
Jmes C. CaBtiman
i 77-2€0 Minnesota
City Zip Tel.: 4
Palm Desert 92260 619/345-54
State Lic. City
& Classif. 13 195333 LiC. # 2oo
Baron., tngr.,
Designer
AddressTel.
City I
Zip . IState
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed. under provisions of Chapter 9 (commencing with Section
7000) oUDivision 3 of the Business and Professions Code, and my licensee iiss in full forrce and
effect• �,r�. !.-i' � ".'6:.` . f �.f/•� ,+'
SIGNATURE - !' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.tiusiness and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Re 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 violation of Section 7031.5 by 'any applicant for a permit
sub)ects the applicant to a civil penalty of not more than rive hundred dollars ($500).
0 .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, Suisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or brmproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, 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.)
❑ 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
Date Owner
)
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
'• O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred- dollars (S100) valuation
or less.)
I certify that in the performance of the 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. If, after making this Certificate or Exemption you should become
subject" to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shaft be deemed revoked.
f
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.)
Lenders Name
Lerider'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 certify that I have read this application and state 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
No. 05509
11LDING: TYPE CONST. OCC: GRP.
P. Number 617-644-058
egal Description IAS58
roject Description Flinn 4
Sq. Ft. 1852 No.
Size Stories
New Add•❑ Alter ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk..Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
No. Dw. ••
Units
Repair ❑ -Demolition ❑
AMOUNT
471.92
563.00
0 XV
♦U
1
REMARKS tV Y c rr
ZONE:
I BY:
Minimum Setback Distances:
Front Setback from Center , ; +
tLine •
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
3/14/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES i
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
i
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS _
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
WALL SQ. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 -
_
GROUND PLUMB NGf'r
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7 v/
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS _
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. s(((R
f4l�f
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.
FINAL INSP.
FRAMING Z(
FINAL INSP.
ROOFING
_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND % 9
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
i,
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL