05511 (SFD)P.O. BOX 1504 No. 05511
ilding 48— 106 Vista Cielo78-105 CALLE ESTADO
dress LA OUINTA,-CALIFORNIA 92253
rner
Ave & Thelma Grossman,
Aaaress 9010 Corhlu 'Ave. S.3
City Zip Tel.
I iorthridge 9332.4 818/149.5894
I J88tffra C.. Ce$Sibm an
Address
1 77-200 Minnesota
City Zip Tel.:
Palm Desert 9226.4 519-345-5430
State Lic. City
& �Classif. $ 395333 Lic. # 260
Arch., Engr.,
Designer
Address' Tel.
City'I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that I am licensed under.provisions of Chapter 9 (commencing with Section
7000)t f Division 3 of the Business and Professions Code, and my license,isrin ull force,and.
e7ecSIGNATURE " i'' DATE
t' OWNER -BUILDER DECLARATION
I-hereby, affirm that I am exempt from the Contractors License Law for the following
reason: (Seca 7031.5,Business 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
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 civil penalty of not more than rive hundred dollars ($500). -
O 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 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.)
O 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 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.)
O 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
f O Copy is filed with the city. O Certified copy is hereby furnished.
i
CERTIFICATE OF EXEMPTION FROM
: WORKERS' COMPENSATION INSURANCE
(rhis section need not be completed 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, l shall not
employ anypperson 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 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 shall be deemed revoked.
r
I '
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.) t
Lenders Name
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.
II 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.
Signature of applicant Date
Mailing Address
city, State, Zip
BUILDING, TYPE CONST. OCC: GRP.'
A.P. Number 611-640-060
Legal Description Lot 60
Project Description Ply 4
REMARKS
" Y. h.i+ :. N.+X K Y^L.' '1 !.. S9"Y . R "T. Fii'ti -_ _..
'11"( r� 45t -A .tr �.r`•,t9� 1^N.'' rs . vTiR 5, # !v a
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 Property1ine
FINAL DATE INSPECTOR
Issued by: Date 3/14/89 Permit
Validated by:
Validation:
Sq. Ft. i152 No.
Size Stories
No. Dw.
Units
New :& Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $82,14a..00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
71.92
Const.
563.00
Mech.
60.00
Electrical
96.97
Plumbing
120.50
S.M.I.
5.81
Grading
Driveway Enc.
A
Infrastructure
,84-8.2
Y e—toad
'.05
TOTAL
1_4 j, C,
REMARKS
" Y. h.i+ :. N.+X K Y^L.' '1 !.. S9"Y . R "T. Fii'ti -_ _..
'11"( r� 45t -A .tr �.r`•,t9� 1^N.'' rs . vTiR 5, # !v a
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 Property1ine
FINAL DATE INSPECTOR
Issued by: Date 3/14/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS° ` s
SLAB GRADE S/7i
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
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. SQ. 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
FRAMINGt yqc/
v
FLOOR DRAIN
MECHANICAL FEES
/L-*
N
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® IVA c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE TNST.
FEE . ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBIN ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE S/7i
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
/yamSEWER
FOUND. REINF. j� �yQ
v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQU1P.
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
110
FRAMINGt yqc/
v
FINAL INSP.
ROOFING
/L-*
N
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING + O YY/V O O
MESH
INSULATION/SOUND 0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL