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08085 (SFD)Building Address Owner ' u P.O. BOX 1504 78-105 CALLE ESTADO 50-M Grand Traverse Ave. LA QUINTA, CALIFORNIA 92253 Mailing I Address 250 E. Rincon City I Zip Tel. tractor Zip 9.1719 State Lic. City & Classif. Al I Lic. # Designer I Address Tel. City ( Zip( State I Lic. # I hereby afflirn thEg4,Vm licensed underypiovisions of 000) of=Division .of the Business and I?ro essions Cc.11 OWN ER -BU I LDEWDECLARATION ! - 1}Hereby affirm that I am exempt from the4ContLactor's License Law for the following reason: (Sec. 7031.5,Business and Professions Co 6 Any city or county which requires a permit to construct, alter, improve, demolish, or rep r 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 for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($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. 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.) O 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 'py is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE his section need not be completed if the (T p permit is /or one hundred dollars ($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. j Date Owner ' NOTICE TO APPLICANT: 9, 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 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 48085 BUILDING: TYPE CONST. _ OCC: -GRP. A.P. Number 769" C 008 Legal Description Brock Haws Project lDescription K*dei 2 tot 27 REMARKS - ,- N � ti 5 w -,n 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 Issued by:_ Validated by: Validation: INSPECTOR Date ilPermit Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition.❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Q Const. Mech. Electrical 123 85 Plumbing S.M.I. Grading Driveway Enc. Infrastructure 1747.56 TOTAL Si;RQ _ rt'ir►4 _ K1 REMARKS - ,- N � ti 5 w -,n 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 Issued by:_ Validated by: Validation: INSPECTOR Date ilPermit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. $ UNITS a COLL. AREA f%SLAB GRADE l— ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. S0. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. I SQ. FT. GAS (FINAL) �if4 9ileM s TEMP. POLE WALL SO. FT. DRINKING FOUNTAIN SQ. FT. ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED T �j� u s �G J LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SPARK ARRESTOR SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL V% LATHING /0 2J' �F0 SO.FT.GAR ® 3/4c HOUSE SEWER MESH 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 f%SLAB GRADE l— ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER — D ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINIF GAS (ROUGH) f/ �3 e( METER LOOP HEATING (FINAL) OTHER APPIEQUIP. REINF. STEEL GAS (FINAL) �if4 9ileM s TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. t� o-ood FINAL INSP. �,JFRAMING / d/ ROOFING `/a b4� T �j� u s �G J REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR 11,V% GAR. FIREWALL V% LATHING /0 2J' �F0 MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL �•,,,�� ` � �••��/ ^\ � �� •�. \:./�••�1.•*/�/�� ' � sl__la /spa �/�.�/'�. �. •:f,�>a%a�� • v�,d�l<,r .� 77, VV BN FORM 116di�F (\ BIA FORM 1486 I y) INSULATION CERTIFICATION ;tr �• This is to certify that, in conformance with the current energy regulations (California Adminis- ``� fY 9Y 9 :.; trative Code, Title 25, State of (alifornia') and approved plans, insulation has been installed in the building located at: ' =-'� LA OUINTA RIVERSIDE I city county I �� Ste' GRAND TRAVERSE AVENUE (rl , % 25389 I \ I Street No. (If Available) Street Lot Number Tract No. 0 �1 DESCRIPTION OF INSTALLATION (� ROOFS (' \ti Type of Material Manufacturer Thickness- R Value*' ' I OWENS CORNING 6 '/2 19 l' EXTERIOR WALLS Type of Material FIBERGLAS BATTS Manufacturer TB .R .AS Thickness 3-5/8"R Va:ae`*_13__ - , (Or Trade Name) ( CEILINGS OWENS CORNING 12" 38 II Type of Material FIBERGLAS BAITS Manufacturer FIBERGLAS Thickness Y' R Value*- 30 (Or Trade Name) SQ. Ft. Covered I BLOWN: Type of Material Manufacturer Thickness No. Bags \ (Or Trade Name) j Wt./Bag SQ. Ft Covered_ R Value** �,, FLOORS �y1 Type of Material Manufacturer Thickness R Value** (Or Trade Home) �I SLAB ON GRADE . Type of Material Manufacturer Thickness R Value** 1, (Or Trade Name) Width of Insulation Inches FOUNDATION WALLS (if required) �*' Type of Material Manufacturer Thickness R Value** �, : (Or Trade Name) ; . 1 (� REMARKS (if desired) I \ General Contractor (Builder) M J BROCK & SONS, INC. License Number . By Title Date ' Sub -Contractor (Insulation Applicator) Accent Insulation Company License Number 274283 (Inwlation, Mann tc.) (Stab "SAME" if some as can"' tractor) By Title Date 10-27-90 \ ('Ce111mn7e AdminitfraGv Cede, En•ryy Insulation Standards, decleresr O(CFR/r from 14c. 1947S of the NoeIM and Sefoty Gds of fon State "Cnrwol:ance. Upson com lotion of tfe :nsluNafian of insulation• a curd of California, corfifying fhot the inwbri en hes been installed In conformance aide M• rmiulrsmoe h of Mese regulations shall be completed and •socwted by —No Certificate of occupancy or similar aertifiaallM that a stoutly soft- Ad lnsulotioo applicator and by Ma builder. This 1-cvlation complionco strvcted hotel, metal• apartment hews*, home at offer rosldential \ card shell be posted of a conspicuous location within the dwelling.—) d.etsing Is habltoblo shall be issued by such a building department (' It on V01u0 Ir tmwswe of ton resistance of a material w building component to the oessag* of hon. The resistance .slue (it) of mots•hpo Insulations shall stet Include any value for mflect(vo fodsg.) anless As, shvct.m of toast sato6*s 0.* oddilwwrn .rretgr Insulation standards established pwsaanl to this doptw.— fore► 116 —0 BUILDING NEWS, INC., 3055 Overland Ave.. Los Angeles, Calif. 90034-.42131870-9811 form 1486-0 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd., los Angeles. Calif. 90026--12131625.5771