05484 (SFD)P.O. BOX 1504 No. 05484
Building 78-105 CALLE ESTADO
Address 49-149 Vista Clel6LA QUINTA, CALIFORNIA 92253
Owner '
I Abe TMItm Grosst*a'a t.
Mailing BUILDING: TYPE CONST: OCC: GRP.
'
Address 9010 COrbi t Ave. 8.�A.P. Number 617-640-033City . ; Zip Tel.
o f 31:32 8181349 589 5 „ Legal Description 'dot 33
Cdntractor Project Description Platt 2
f James C. C"bman
Address
77-200 Hinnewt£t
-y
I Pat reser
State Lid
& Classif. g 1.95333
Arch.; Engr.,
Designer
Address,
32260 l-9/345--5430
City
Lic. # 210 .
Tel.
City Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commenci
7000) t. of. Division 3 of the Business and Professions Code, and my license is
It
OWNER -BUILDER DECLARATION
I I herebyaffirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,11trsiness and Professions Code: Any city or county which requires a
permit to constrict, =alter, improve, demolish, or repair any structure, prior to its issuance also
requires the'applicant for such permit to file 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 Cade, 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 civilpenalty of not more than rive hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees;
provided that such Improvements are not intended or offered for sale. If, however,'the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
0;1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project- (Sec. 7044, Business and Professions- Code: The Contractor's License. Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
0 1 am exempt under Sec B. & P.C. for this reason
Date owner
n
WORKERS' COMPENSATION DECLARATION
1 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol-i�cy No. Company •
yCO Copyisfiled with the city. 0 Certified copy is hereby furnished.
i
I CERTIFICATE OF EXEMPTION FROM
+ WORKERS' COMPENSATION INSURANCE
(This section need not be completed- if the permit is for one hundred dollars ($ 100) valuation
or Jess.)
I certify that in the performance of thip 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: t, 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.
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.) .
Lender's Name
Lender's Address
hThis is a building 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
Sq. Ft. r No. No. Dw.
Size 1>�2. Stories Units
New Add .❑ Alter ❑ Repair ❑ Demolition ❑
h
ZONE: `
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Estimated Valuation
^.�1s928•flfJ
PERMIT
AMOUNT
Plan Chk. Dep. ,
Side Setback from Property Line
Plan Chk. Bal.
5.38.08
Const.
643.00
Mech.
60.00
Electrical''%
114.83
Plumbing
138.3
S.M.I. -
•
Grading
Driveway Enc.
Infrastructure
Z7U�S
Iyk USB toe
a C9
TOTAL
REMARKS C
... .. r • _ • ^�
W-iif F1*01r ���,y�, . 42 �
h
ZONE: `
BY:
Minimum Setback
Distances:
Front Setback from Center Line
- Rear Setback from Rear Prop. Line
r
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
3114/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE,
NO. — ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
UNITS
COLL, AREA
SLAB GRADE
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
ER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
F NAL INSP. •
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
VENTILATION
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® VV4c
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 �n rs ELECTRICAL HEATING & AIR COND. SOLAR
_1
SETBACK
GROUND PLUMBING
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
ER 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.
F NAL INSP. •
A
FRAMING 7 9 t
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ((�
MESH
INSULATIONISOUND -7/1
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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