05494 (SFD)i
:f
' Building
48-129 Vista Gala
' Owner
M Abe & lm-. Grosomm
Mailing "
Address 9010 Corbin Ave • 9.3
4
UCity Zip Tel.
f NDxttridge 91324 8118/349-5894
Contractor
Jams C. Cashman
Address
1 77-200 ; i=iesota
city' Desert Zip 92260 T%,9/3�5 543,
State Lic. City
& Classif. ' B 195333 Lic. #. 260
Arch., Engr.,.
Designer
i
Address. Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
V 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 arpdn.
effect. / f / j•
SIGNATURE ,/ r DATE
OWNEWBUILDER DECLARATION
I°hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8us ness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demaTish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Conlractor'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 viollaticn or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five 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, Buisness and
Professions Code: The Conhactor'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
orlimprovement is sok/ within one year of completion, the owner -builder will have the burden
or proving that he did. not build or improve for the purpose or sale.)
❑ill, 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.)
❑ l am exempt under Sec B. & P.C. for this reason
1
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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. .pany
tO Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed ff the permit is for one hundred dollars (8100) valuation
orless.)
I certify that in the perfomwlce 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: tl, after malmg this Certificate of Exemption you should become
subject to the workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shag be deemed revoked.
I
I CONSTRUCTION LENDING AGENCY .
I
I 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
Lender's Address
I This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certity 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'
BUILDING: TYPE CONST.
A.P. Number 617-640--043
Legal Description Lot 43
Project Description Plart 3
No. 05494
OCC: GRP.
TOTAL.
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. 1852 No.
Size Stories
No. Dw.
Units
New Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback fro..Pf.�perty Line,,,
FINAL DATE
INSPECTOR
3/1/9
Issued by:
Estimated Valuation $102,226.00
Validated by:
PERMIT - -
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
fi •
Const.
is
Mech.
Electrical
•
Plumbing
144.50
S.M.I.
..�
Grading
Driveway Enc.
Infrastructure
ger x•09
ge—toed
TOTAL.
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front.Setback from Center Lirie
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback fro..Pf.�perty Line,,,
FINAL DATE
INSPECTOR
3/1/9
Issued by:
Date Permit
Validated by:
Mailing Address Validation:
City_ State, Zip
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS °
SLAB GRADE `�
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
S (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. 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
FRAMING Z'd ��' FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
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, TEMIPERM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ff
GROUND PLUMBING bq�
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.
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
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
FRAMING Z'd ��' FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL �
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
I
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL