05515 (SFD)�l i��l'I�I fiV
P.O. BOX 1504., N Q. 0 5 5 15'
Building Vii$ -11 Vista Cielo 7&105 CALLS
Address LA QUINTA, CALIFOORNIARNIA 9 92253
Abe & Thelma Grosmwn
Address 9010 C04bin A®e. S.3
City Zip Tel.
. t Nortbridge 91324 &181349-5e
Contractor
James C. Cashmn
Address
I 77-200 Minnesota
CityZip Tela
A _a 60 619/345-510
State Lic. City •
&'Classif. ;$ 195333 1 Lic. # 260
Designer
Address' Tel.
i
I
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
11 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sec)ion
7000) of Division 3 of the.Business and Professions Code, and my license is in fullforceand,
effect,A=-+'.'..a✓i!? �i-•':'!�'pi.•..J�.<.- •'��:-"i'i'i-..._._.__� �l fl'd ��%
5 SIGNATURE ~•j' ! f' DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason:. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demofrsh, or repair any structure, prior to its issuance also
requires. -Ne applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions "ol. 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 five hundred dollars (S500). •
❑ 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. ff, 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.)
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Dale Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I 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
' Yl_ 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 pemmT is for one hundred dollars ($100) valuation
or less.)
i I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT.' ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shat be deemed revoked.
I
}
i CONSTRUCTION LENDING AGENCY
; Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
! This is a building permit when properly filled but signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
11 car ity that I have read this application and state that the above information is correct..
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the .above-.
mentioned property for inspection purposes.
I'
Signature of applicant Date
Mailing Address
City, State, Zip
i
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 6,17-640-064
Legal Description Lot 6
Project Description
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 3,14% Permit
Validated by:
Validation:
Sq. Ft. No.
Size .$ '° Stories
No. Dw.
Units
New Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $104,139.00
PERMIT .
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
544.73
Const.
657.4!0?
Mech.
.
Electrical
113.36
Plumbing
126.50
S.M.I.
7..3
Grading
Driveway Enc.
2s3 3•
IInfrastructure
TOTAL
REMARKS
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
Issued by: Date 3,14% Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES j
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE /
v7
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CARP. SO. FT. ®
GAS (FINAL) % 1—
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Lc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBI& / ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /
v7
ROUGH PLUMB. (59-07—
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 5/3�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) % 1—
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.yd.
$ plus x$
=$
LUMBER GR. /�FINALINSP.-`.-�.-1
FRAMING �I %Z� FINAL INSP.
(((
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Q 6
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
ccrdro nuw�
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W-
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL