05488 (SFD)Building
Address
48-14I Viwtrs Clelo
Abe Thelma Grassmn
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address _ 9010 Cbrbir Ave. 5.3
City
Zip
Tel.
o+r Perk «e
91324
818/349.5.€€94
Contractor .
Js C. Casa
Address .
79-200 Mi soca
City
Zip
Tel.:
I 11alm,. hesert
92260
619j345-5430.
State Lic.City
& Classif. B 195333
Lic. # 260
Aech.', Engr., .��
Designer. 4
Address `
Tel.
City Zip State
a Lic. #
1. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
of L i Division 3 of the Business and
Professions Code, and my license is in fulllfffoorce.a_nd1,,,,
SIGNATLRE F DATE
ki OWNER -BUILDER DECLARATION '
} I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: ,'(Sec.•7031.5,Business and Professions Code: Any city or county which requires a
Permit to .construct, after, brmrove, 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 taw, Chapter 9 (commencing with Section 7000) of
Da4sion 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
builds or bnproves 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 bind or improve for the purpose of sale.).
❑ -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 cormtractor(s) licensed pursuant to the Contractor's License Law.)
1 .
❑ 1 am exempt under Sec B. & P.C. for this reason
c
Date Owner
f 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
b Copy is filed with the city. ❑ Certified copy is hereby furnished.
i CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Ihis 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, I shall -not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date • Owner
NOTICE TO APPLICANT. If, after making this Certificate of .Exemption you should become
subject to the Workers' Corrmensation provisions' of the Labor Code, you must forthwith
comply with such provisions or This perdt shall be deemed revoked.
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, Cin? 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.
i
Signature of applicant— Date,
Mailing Address
City, State, Zip
r n
No. 05488
BUILDING: TYPE CONST.' OCC: GRP.
A.P. Number 617-640-037
Legal Description Iot 37
Project Description Sian 2
Sq. Ft. 1852 No. No. Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuationi�,�.c�a
PERMIT
AMOUNT
Plan Chk. Dep. '
Plan Chk. Bal.
•
Const.
3,000
Me h.
60.00
Electrical" 0 +
110083
Plumbing .
138.50
S.M.I.
7.07
Grading
Driveway Enc.
Infrastructure
2,2 0.88
FrInse- t. 00d
TOTAL
s `/�/r�1..
REMARKS
.
�,t-'li: •�3•...St2-,i i:"i� 3•"�a�".,t'S Y`t,Yv ys. r "i.�d � w'Yt.. •^�J
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
3114/89
Issued by. Date Permit
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE I' f/I
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING �l
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL -7
LATHING 7
MESH
INSULATION/SOUND 7 �7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
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.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Lc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
----JCONST.
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING �,44LECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I' f/I
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.�
GAS (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.FINAL INSF//�2 �
FRAMING % , FINAL INSP.
ROOFING �l
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL -7
LATHING 7
MESH
INSULATION/SOUND 7 �7
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL