9832 (RR)4
A 44 _\`S�
k
P.O. BOX 1504
Building 7g-132 LAGO�78 144 LAGO LAQUINTAC
Address CALFORNIA92253,�
Owner
BAER
Mailing
Address 78-132 LOGO
City Zip Tel.
LA.QUINTA,CA 92253
Contractor
O.L. HHN•SS CONSTRUCTION
1773 CINDY COURT
City Zip Tel.:
CORONA, CA 191720 714-736-9744
State Lic. City
&Classif. 467027BgC39 Lic.#
Designer
Address I Tel.
City 1. Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
eby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
of Division 3 of the' Business and Professions Code, and my license is in full force and
OWNER1BUILDER DECLARATION
I hereby at 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, atter, 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
Division 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 penalty of not more than five hundred doflars.($500).
❑ 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; 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. lf, however, the building
or improvement is sold within one year of completion, the owner-builder.wilf-have the burden
of proving that he did not build 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. - B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION - e�
I hereby affirm that I have a certificate of consent to,,self-insure?'or a certificate of
Worker's Compensation Insurance, or a certified cogy thereof. (Sec. 3800, Labor Code.)
Poll No '�-�. Company E
Copy Is filed with the city, O Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is./or onehundreddollars ($100) valuation
or less.)
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 California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must ' lorthwith
comply with such provisions or this permit shell be deemed revoked.
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
This 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
No. 9832
WING: TYPE CONSTREROOF OCC: GRP.
P. Number
Legal Description
Project Description
..FROM SHARE
REROOF WITH TIM
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑.
'. -Demolition ❑
Estimated Valuation
$15.000
PERMIT
AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal.
Const.
$81.00
:§A*9-Xk9
Mech.
Electrical
Plumbing
S.M.I.
.75
Grading
Driveway Enc.
Infrastructure
TOTAL $81.75 16135=15M
j I'
REMARKS
Anr,4w3 in
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
^ 1 Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date - Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 114c
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
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)
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
FINAL INSP.
ROOFING
Qt L
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION �r
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
G. L. HENSS ROOFING AND CONSTRUCTION CO.
1773 Cindy Court, Corona, California 91720 (714) 736-9744
lic. no 467027
PROPOSAL and CONTRACT
PROPOSAL SUBMITTED T(j� �
PON
GATE-
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STREET.
JOB
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CITY, STATE AND IIP C04E
ARCHITECT
DATE OF PLANS
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JOB PHONE cj
We hereby submit specilicalumc and esUmdles foe
"NOTICE TO OWNER"
ISection 7019 -Contractors License Law)
"Under the Mechanics Lien Law, and contractor. subcontractor. laborer, malerialman or other person who helped to improve your property and is not paid for his labor, services or material, has a
right to enforce his claim against your property.
"Under the law, you may protect yourself against such claims by tiling, before commencing such work or improvement, an original contract lot the work of improvement, ora modification thereof,
the office of the county recorder of the county where the property is s it ualed and tequ in ng that a contractor's payment bond be recorded in such office Said bond shall be in an amount not leas than
fifty percent (50%) of the contract price and shall .n addition to any conditions for the performance of the contract, be conditioned for the payment in lull of the claims of all persons furnishing labor,
service. equipment or materials for the work described in said contract.
DAMAGE TO PREMISES
WH E N.IN THE PROCESS OF ROOFING OR DEMOLITION PRIOR TO REROOFING. RAIN OR OTHER ACTS OF GOD OCCUR AND INTERIOR DAMAGE RESULTS,THE CONTRACTOR SHALL
NOT BE HELD RESPONSIBLE. EFFORTS TO EXERCISE REASONABLE PRECAUTION SHALL NATURALLY BE USED.
WE PROPOSE hereby to furnish material and labor — complete in accordance with above specifications, for the sum of
�% P � n--�-�[tic1 t �S c� � 1M, � •� �
----Is 1b, moo• a
Paym nt to be made as follows:
All material is guaranteed to be as specified. All work to be completed In
a workmanlike manner according to standard practices. Any alteration
or deviation from above specifications involving extra costs well be Authorized �•�.
executed onlyuponwrittenordersand will becomeanextra chargeover Signature ZZ,
and above the estimate. All agreements contingent upon strikes.
.accidents ordelaysbeyoFdour control. Owner tocarry fire. tornado and Note: This proposaly be withdrawn �O
other necessary insurance Our workers are fully covered by Workmen's by us II not acceple within days
Compensation Insurance.
ACCEPTANCE Of PROPOSAL - The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are author-
ized to do the work as specified. Payment will be made as outlined Signature P1 (/lJ
above.
Date of Acceptance: D —Nn— 91Signature
r
JOSEPH N. CICCHINI
CIVIL ENGINEER, INC.
► Civil & Structural Engineering
71321 Hwy. 111 Suite 4
RANCHO MIRAGE, CALIFORNIA 92270
(619) 341-2273
COs G. I_ . I -I E N S S RD D F► G
SHEET NO. I OF
CALCULATED BY DATE / Z3
.CHECKED BY DATE
ccei c
M r la.ge onecai �wr Irgoeol U® enc. Gram. MM. 0I/7I. To Or0er PHONE TOLL FREE I -M225 -M
c
JOSEPH N. CICCHINI
3CIVIL ENGINEER, INC.
Civil & Structural Engineering
71321 Hwy. 111 Suite 4
RANCHO MIRAGE, CALIFORNIA 92270
(619) 341-2273
JOB G. L . W ENS -s kooff N G
SHEET NO. ( OF
CALCULATED BY pqZE 7 23
•CHECKED BY DATE
—� 1—i ii."'.. -- m. a s. u - muni iuumt1,WTn'=
JOSEPH N. CICCHINI
CIVIL ENGINEER, INC.
Civil & Structural Engineering
71321 Hwy. 111 Suite 4
RANCHO MIRAGE, CALIFORNIA 92270
(619) 341-2273
JOB G L. W EN S QDof 1'p N G
SHEET NO. I OF
CALCULATED BY DAA / Z3
.CHECKED BY DATE
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