05493 (SFD)P.O. BOX 1504 No. 45493
Building 48-131 Vista Melo LA QUINOTAC
Address CALIFORNIA 92253
I . Abe & Thelma Grosamm
Mailing
Address 010 00 ff><3n Ave . S.3
City Zip Tel.
i midge 91324 818/349.5894
Contractor
• 7amea C. Cash's
Address" .
77-200 Minnesota
Palm Desert ` r 92.260 6191345-5430
State Lic. City
& Classif.. B 395333 Lic. # 260
Arch:, Engr.,.
Designer
Address' Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1� hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
♦_ SIGNATURE -- e _ ,Y DATE
OWNER -BUILDER 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, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
DWsfon 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 penally 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
brnlds 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 knprove for the purpose of sale.)
0, 1, 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
�O Copy is filed with the city.. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
V WORKERS' COMPENSATION INSURANCE
(Tris section need not be completed if the permit 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,, 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 shall be deemed revoked.
i
r
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
Lenders Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I 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. L W r
A.P. Number 617-640-042
Legal Description L*t 42
Project Description Z
OCC: GRP.
Sq. Ft.
Size 3852
No.
Stories
No. Dw.
Units
New C} Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$96,142.40
PERMIT-'
AMOUNT
Plan Chk.'Dep.
Plan Chk. Bal.
:Z •
Const.
626.00
Mech.
67.03:;
Electrical
107.28
Plumbing
132.E
S.M.I.
•
Grading
Driveway Enc.
Infrastructure
2,163.19
i e.'aGtre
_ a"
TOTAL
REMARKS ,WWr-rWi.c.id!-r:a!n J41+4$7—POPJ..,r% ,• RA
...( "'l.'5ilf•.! K"Y'.1 iZY.. u ,.a c.r .. r+
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 Pzrope-ty,Line:
.r,
�..
FINAL DATE INSPECTOR
Issued by: Date 3/14/89 Permit
Validated by:_
Validation:
CONSTRUCTION ESTIMATE
+ NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. 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.
SO 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
ROOFINGS4,6
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
E
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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+/e c
SEWAGE DISPOSAL
LATHING f
MESH
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
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING _ ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING c01
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.
GAS (ROUGH)/0 a 0
` v
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.
FRAMING 7 7
FINAL INSP.
ROOFINGS4,6
O
/
77-
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLS-// -7
IREWALL !? ,
LATHING f
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL