05492 (SFD)Building
Address
Owner
48-133 Vista G%lu
Abe & T?tel%&a ,Grosstwn
Address , 9010 Corbin AVe• S•3
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City
Zip
Tel.
L Northridge
91324.
815/349-3834
Sq. Ft. 1852
Size " .
No.
Stories
No. Dw.
Units
Contractor
'James C. Cashm=
Address
t 77-•200 Minnwota
City
Pat= `Desert
Zip
9226{3
Tel
619/ 5-543Q
State Lic.
City
& Classif. B-195333
Lic. # 260.
Arch:, Engr.,
Designer
Address
Tel.
City (Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
U hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70D0) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
_ l;�'�.'..��r+als^. `7 t' - a�i'�/` E_ �e:'•%r''.�• r � I' f i ! r .., i'.
SIGNATURE •'' DATE
'v:�,„ OWNER -BUILDER DECLARATION
r I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bushess and Professions Code: Any city or county which requires a
permit to constrict, ager, irprove, 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 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 exerrption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of Trot more than rive hundred dollars (5500).
❑ 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, Suisness and
Professions Code: fire Contractor's License Law does not apply to an owner of property who
buWs or improves thereon and who does such work hinself or through his own employees,
provided that such rrprovements 'are not Wended or offered for sale. If, however, the building
or l improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not brae of improve for the purpose of sale.)
p 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 bw7ds or improves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.)
1
❑ 1 am exempt under Sec- B. & P.C. for this reason
r
r
Date Owner
P WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
r WORKED' COMPENSATION INSURANCE
(This section need not be ar Pliated if the permit is for one hundred dollars ($100) valuation
or less.) •
t 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 CalifomI I.
Date Owner
NOTICE TO APPLICANT. d - after maAig this Certificate of Exemption you should become
subject to the workers' compensation provsions of the Labor Code, you -must forthwith
comply with such provisions or Oris Pem* shall be deemed revoked. "
S
CONSTRUCTION LENDING AGENCY
l 1 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 property 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
No. 054,92
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 617-640-041
41
Legal Description
Project Description ple tt
r
Sq. Ft. 1852
Size " .
No.
Stories
No. Dw.
Units
New 7 Add ❑ Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
$96J42•00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
N
Const.
`Z •
Mech.
1bU • 00
Electrical
.Z
Plumbing
325
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
.Jy'
REMARKS
,
�%i:ti•%��f
�'y���.�•t.iiY"= � i r�"f"�`ia:tst ''•at
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: 3/14/81 Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. gQ, FT_ ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL) /
WALL - SO. FT.
DRINKING FOUNTAIN.
SQ. 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 S'
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
SPARK ARRESTOR
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vic
HOUSE SEWER
MESH
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 GOND. SOLAR
SETBACK
GROUND PLUMB G
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)
Q
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) /
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR�.y
FINAL INSP.
FRAMING (�
FINAL INSP. ii _�
ROOFING S'
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL
21
LATHING
MESH
INSULATION/SOUND /J.
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
,