05500 (SFD)P.O. BOX 1504
dress: 48^117 Vista ClelQ LA QUINTA8-105 CCAL CALIFORNIA 92253
dress
Owner
I Aba & 3'helm Grosamm
Mailing
Address 901€3 Cor'biaa..Ave. S•.3
City Zip Tel.
- Horthruee �3832t� 8I ./349 I
I . James C..
77-200 ?imcsots ,
t Pa Desert 92260 613/345-5430'
State Lic. City
&'Classif: .. 6naAftnLic. # ..,.,.
Address Tel.
t
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
111 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of, Division 3 of the Business:and Professions Cade, and my I
effect-', cense is in full force and
i
�S....... r DATE
OWNEWBUILDER DECLARATION
• I�hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busihess 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 Me a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 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 Contractors 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 buil or irprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
structthe 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.)
t '
O 1 am exempt under Sec. R- 8 P.C. for this reason
I
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
D Copy is filed with the city. ❑ Certified copy is hereby furnished.
'i
CERTIFICATE OF EXEMPTION FROM
WORKED' COMPENSATION INSURANCE
(This section need not be consmWed ff the pemr7 is for one hundred dollars ($100) valuation
or less.)
I I certify that in the performance of thg 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: tl, 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 shag be deemed revoked.
I
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.)
Lenders Name
Lender'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.
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
t
Signature of applicant Date
Mailing Address
City, State, Zip
No. 05500
11LDING: TYPE CONST. -OCC: GRP.
P. Number 617-640-049
tgal Description Ut 49
oject Description Plan I
Sq. Ft. iso No. No. Dw.
Size Stories -Units
New 19 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $96,142.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
•
Const.
•
Mech.
60 i. 013
Electrical
IT17.24
Plumbing
S.M.I.
3
19
Grading
Driveway Enc.
Infrastructure
s
TOTAL
REMARKS 42".44 0r4 4 N , $: +, 7-0. ."
. ilii`"", ". GY':.}1•.F' Jai" 'Y YyY.i'iSa" i' �+ � '+ .x a r'u '
ZONE: BY:
Minimum Setback Distances:
Front Setback fro Center Line
Rear Setback from Rear Prop. Line1
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
N0. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp, FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING �• ��
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
LATHING 01,0- elm
SO.FT.GAR ® VVac
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 PLUMBING��ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
fr 7w
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. (�
Of
r S (ROUGH)/D i
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.
i
FRAMING
INAL INSP.
ROOFING �• ��
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 01,0- elm
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
�
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1