9833 (RR)44
P.O. BOX 1504 , 6 N o. 9833
Building 78-144 LAGO LA QUINTA78-105 CCAL FORNIA 92253
Address
Owner
BAKER BUREROOF
Mailing ILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
Legal Description
Contractor Project Description REROOF WITH TIRE (FROM
G. L. HiNSS CORSTRUCTON SHARE)
Address `
1773 CINDY COURT
CityZip Tel.:
13o
CO b 3 . 7klA
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7lXX)) t. of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE A DATE
`%OWNER -BUILDER DECLARATION
I hereby affirm that laa'm exempt from the Contractor's License Law for the following Estimated ,��5
$ 7 Valuation
reason: (Sec. 7031.5,Buslnes��q
"s and Professions Code: Any city or county which requires a - R
Permit to construct, atter, 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 PERMIT AMOUNT
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 Plan,Chk. Dep.
'subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
-❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness andConst.5 v n) ssis
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
slruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law rgg
does not apply to an owner of property who builds or improves thereon, and who contracts for • S.M.I. J
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. ti P.C. for this reason
Driveway Enc. .
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to elf -insure, orfla- certificate of; r
Worker's Compensation Insurance, ora certified copytliereof (Sec. 3800, Labor Code.)
Policy No. Company
'� \�j
VCopy Is filed with the city. ❑ Certified copy is hereby furnished.
\,�
TOTAL 7i i • k !... J
CERTIFICATE OF EXEMPTION FROM REMARKS �-
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.) _
I certify that In the performance of the work for which this permit Is issued, I shall not 10
employ anyparson in any manner so as to become subject to the Workers' Compensation a ,
Laws of California.
Date Owner'
NOTICE TO APPLICANT: If,- after making this Certificate of Exemption you should become ZONE: BY:
subject to the' Workers' Compensation provisions of the Labor Code, you must forthwith i �Wif l'Mum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
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
FINAL DATE INSPECTOR
Issued by: Date.v' ' Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
IKITCHEN 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 Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
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 r
nn
Q_L tog
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
oe
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
G. L. HENSS ROOFING AND CONSTRUCTION CO.
1773 Cindy Court, Corona, California 51720 (714) 736-0744
lic. no 467027
PROPOSAL and CONTRACT
PROPOSAk SUBMITTED TQ.�
!
PON
DATE � l
STREET. , V
JOB
CITY, STATE AND IIP CO E
Or Mck
t-clainil r _ O
ARCHITECT ]DATE
OF PLANS
LG
JOB PHONE
We hereby submit specehCdtions and e•slimdles lot
"NOTICE TO OWNER"
(Section 7019•Conlraclors License Law) f
-Under the Mechanics Lien Law. and contractor, subcontractor. laborer. materialman 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, or a modification thereof, to
the office of the county recorder of the county where the property is situated andrequeringtnalaconlraclor'spaymentbondberecordedinsuchoffice.Saidbondshallbeinanamountnotlessthan ,l
fifty percent (50%) of the contract price and shall in addition to any conditions lot the performance of the contract. be conditioned for the payment in full of the claims of all persons furnishing labor,
service. equipment or materials for the work described in said contract. ,
DAMAGE TO PREMISES
WHEN.IN THE PROCESSOF ROOFING OR DEMOLITION PRIOR TO REROOFING.RAIN OR OTHER ACTS OFGOD OCCUR AND INTERIORDAMAGE 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:
Paympot to be made as follows:
dollars ($ X. S1 t1"!
j1- o `�
All material is guaranteed to be as specified. All work to be completed in i
a workmanlike manner according to standard practices. Any alteration
or deviation from above specifications involving extra costs will be Authorized ?
executed only upon written orders and will becomean extra charge over gignature ! ;,
and above the estimate. All agreements contingent upon strikes.O
accidents or delays beyoFidour control. Owner tocarry lire. tornado and Note: This proposaly be withdrawn ..,�
other necessary insurance. Ourworkers are lullycovered byWorkmen's by us if not accepts within
Compensation Insurance. days t!
ACCEPTANCE OF PROPOSAL - The above prices, specifications and {n!
conditions are satisfactory and are hereby accepted. You are author-
ized to do the work as specified. Payment will be made as outlined Signature
above. r�r.
Date of Acceptance: r s,.�_�' Signature 1
�o�
JOB- .G. L, W E N S S RoD f:'1 )-1 G
JOSEPH N. CICCHINI
CIVIL ENGINEER, INC. SHEET NO. ' OF
Civil & Structural Engineering DATE 23
71321 Hwy, 111 Suite 4 CALCULATED BY
RANCHO MIRAGE, CALIFORNIA 92270 CHECKED BY DATE
(619) 341-2273
JOSEPH N. CICCHINI
CIVIL ENGINEER, INC.
Civil & Structural Engineering
71321 Hwy. 111 Suite 4
RANCHO MIRAGE, CALIFORNIA 92270
(619) 341-2273
JOB_ G. L' WEW4S "oroNG
SHEET NO. ( OF
CALCULATED BY G DAA Z3
•CHECKED BY
DATE
PRODUCT 201-1(S6g1e Shear) 2051(Pad" ®e 0x., Omfm, Man. 01471. To Order PHONE TOLL FREE 1400.2256380
JOSEPH N. CICCHINI
CIVIL ENGINEER, INC.
Civil & Structural Engineering
71321 Hwy. 111 Suite 4
RANCHO MIRAGE, CALIFORNIA 92270
(619) 341-2273
JOB G L. HEN S ko&ri ?-1 G
SHEET NO. I OF
CALCULATED BY DATE Z3
•CHECKED BY DATE