05510 (SFD)• �IGl�fi�/ •
P.O. BOX 1504 No. 05510.
Building 43-142 Vista Cielo 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Ave & The1m Grossman
Address 9010 CarbIA Ave. S.3
City • I Zip Tel.
North 91324 818/349-539 ►
.dames C. Css$Y.J�m
77-200 Mwtaeota
City ' Zip Tel.:
: Palm Y� sert 92260 0l
State Lic- City
& Classif. i 4s Lic. #
Arch, Engr-,
Designer
Address Tel.
I
City Zip State
` Lic. #
j LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and ,
effect. .�,� F� .•r. ?--r f�%y�._.✓r/ff✓�Ir
{ SIGNATURE ,r 1' DATE
O OWNMBUILDER DECLARATION
�I hereby,affirin that I am exempt from the Contractor's License Law for the following
reason. (Sec. 7031.5,13usiress and Processions Code: Any.city or county which requires a
permit to construct, after, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to flea signed statement that he is licensed pursuant to
the provisions of the Contractors License taw, 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 ($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 irproves 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 inprovemrent Ls sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or irprove coil the purpose of sale.) 1:11, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec- 7044, Business and Wofessions Code: The Contractor's License Law
does not apply to an owner of property who buiids 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 Seri B. & P.C. for this reason
Date owner
f WORKERS' COMPENSATION DECLARATION
I 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
y❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
Z CERTIFICATE OF EXEMPTION FROM
I WORKERS' COMPENSATION INSURANCE
(This section need not be corrpleted if rhe permit is for one hundred dollars ($100) valuation
or less.)
1 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: ff, after making this Certilkate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions 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
Lenders Address
This is a building permit when property filled out, signed and validated, and is'subject to
expiration if work thereunder is suspended for 1110 days. '
I certify that I have read this application and state that the above iriformation.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
BUILDING: TYPE -CONST. a & � OCC: GRP.
A.P. Number 617-640-059
Legal Description Lot 59 -
Project Description Plan '
Sq. Ft. 1352
Size
No. No. Dw.
Stories Units
Newt'❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$104.139.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.,'
Const.
Mech.
Electrical
Plumbing
S.M.I.
—Grading
Driveway Enc.
Infrastructure
Fringe -toad
TOTAL
AMOUNT
1 544.73
657.€ 0
160.0 -
113.,3:96
126.59
.
2,343.13
3 �
REMARKS at
_
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
3%14/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE ' v v
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING Z
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yac
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 PLU=G ELECTRICAL HEATING & AIR COND. SOLAR
4.
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ' v v
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF. y
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.
INAL INSP./';I/
FRAMING Z
AL INSP.
ROOFING
,{
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLA,''
LATHING � wlil O R/ -
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t