08087 (SFD)Building
Address16,"t 7
Owner
14J. Brink
4
P.O. BOX 1504 / N o .
78-105 CALLE ESTADO CY/
c� LA QUINTA, CALIFORNIA 92253 js
BUILDING: TYPE CONST. 1i OCC: GRP.:
maumg
Address M RinCon St
City I Zip ITel.
Contractor
City Zip Tela
State Lic. City
& Classif.636 Lic. #
412
Arch., Engr.,
Designer
Address I Tel.
City [Zip
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm -that [,am licensed under,6rovisions of Chapter 9 (commencing with Section
7000) of Division 3 0 "the eus`iriess a d' Professions Cod ? and my license is.in full force and
effect. ✓`
SIGNATURE " J' - - - `" " A `DATE
I h�/y OWNER -BUILDER DECLARATION '
by affirm that I am exempt from th;e,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, 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 Code, or that. he is exempt therefrom, and the basis
foifp,'O!,alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
. subjeots'the applicant to a civil penalty of not more than five 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 or sale.)
❑ I, 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
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
❑..eopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
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: It, 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.
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 it 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 properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number 769-040-008 & 021
Legal Description QT` ck nomas
Project Description modol Q 1 %o —20
{ R •
Sq. Ft. 3onr No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. d
Const.
Mech.
.60
Electrical "°
1 '�
Plumbing •
50
S.M.I.
1!5 33
Grading
Driveway Enc.
Infrastructure
TOTAL I 797fa 17 1 7n9A _ 17
REMARKS
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: Date !' Q Permit
Validated by:
Validation:
... _ ��"'1 t• �- r0. s`�' 'r , I,".` .� — _} �..� �� `, --, � � ,� k�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER/ �_
ROUGH WIRING
GAR. SO. FT. 0
POWER OUTLET
ROOF DRAINS
FOUND. REINF.��q"
GAS (ROUGH)w—Alk�a14METER
DRAINAGE PIPING
CAR P. SO. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL S0. FT.
GAS (FINAL)/ f/�-9��
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
�GGAR. FIREWALL4-D,,%j I0 -30-q
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 COND. SOLAR
SETBACK
UND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
CSLAB GRADE —`l —G 6
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER/ �_
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.��q"
GAS (ROUGH)w—Alk�a14METER
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)/ f/�-9��
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
—Plus—x$—=$
LUMBER GR.
FINAL INSP. Q
FRAMING
FINAL INSP.
)MjROOFING9
70'eM �O,ly LxA
%� ��v/► (/
REMARKS:
VENTILATION
FIRE ZONE ROOFING`%67)�
FIREPLACE
SPARK ARRESTOR
�GGAR. FIREWALL4-D,,%j I0 -30-q
LATHING
MESH
�. IINSULATIONISOUND/L9 ,25-/0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
41
BN FORM 116
BIA FORM 1486
INSULATION CERTIFICATION
This is to certify that, in conformance with the current energy regulations (California Adminis-
rf trative (ode, Title 25, State of California`) and approved plans, insulation has been installed in
the building located at:
LA QUINTA RIVERSIDE
city County
GRAND TRAVERSE AVENUE 25389
Street No. (it Available) Street Lot Number Tact No.
f.
DESCRIPTION OF INSTALLATION
ROOFS I is
Type of Material Manufacturer Thickness—11 Value** -
6 1/2 19
EXTERIOR WALLS OWENS CORNING
Type of Material FIBERGLAS BATTS Manufacturer FIREEM -AS Thickness 3-5 /8R Va!;je**-13--
(Or Trade Name)
CEILINGS 1211 38
BAITS: OWENS CORNING
FIBERGLAS BATS Manufacturer FIBERGLAS Thickness 91-2" R Value" 30
Type of Materia (Or Trade Home)
lit.
Sq. Ft. Covered
BLOWN:
Type of Material Manufacturer Thickness No. Bags—
(Or Trade Name)
WL/Bag Sq. Ft Covered R Value**FLOORS
Type of Material Manufacturer Thickness R Value**—
(Z
(Or Trade Name)
SLAB ON GRADE
Type of Material Manufacturer Thickness _-R Value"
(Or Trade Home)
Width of, Insulation Inches
FOUNDATION WALLS (if required)
Type of Material Manufacturer Thickness—R Value**—
(Or Trade home)
REMARKS (if desired)---
Ile
General Contractor (Builder)- M J BROCK & SONS, INC. License Number
By Title Date Jl
Sub -Contractor (Insulation Applicator)- Accent Insulation Company License Number 274283
(Insulation. Mown tc.) (State "SAME'- if some as General tru"cto'd T,
C"
By oe-e:� Title Date 10-27-90
I •oCalifornia Administrative Code. Energy Insulation Standards, declares, Exatrr from sec. 19a7s at she ..i* sad so" cds of the state
"C&V6onc*.' Upon caolot'-ors of she installation of insulation• a cord of California,
c-140.0 that the inwbrien has been insiallod In conformance with the
.1 those esill.lations shall Is• completed end qstecutsod by certificate of occupancy or similar Certification ".Of a stouly cen-
"oplimts"and by the builder. This 1=:vlat;on cmpl;onca strutted hosol, motel, apartment house, kawo m, other meldontial
cord tholl be pe6lod of a conspicuous location within she dwelGog.") al�effivtg Is habitable shall be issued by such a building department
ss 0. struct
unleure, t least eatie645 0.0 minimum energy jasuletieft
('*a Volvo Is she measwe of " rsssisfcsnca of a material or building standards established pursuant to this chapter.'* 11
10-90"At to the passage of heat. The retstatence value (tj of watt -type
I-s.lati"s shall met 4n4vdo any volve for ftflectf.* feting.)
Form 116 —it BUILDING NEWS, INC.. 3055 Overland Ave., Los Angeles, Calif. 90034-4213)870-9871
Form 1486-0 BUILDING INDUSTRY ASSOCIATION Of CALIFORNIA. INC, 1571 Beverly Blvd, Los Angeles, Calif. 90026-4213) 625-5771