08084 (SFD)Building
Address
Owner
QUM Ov
P.O. BOX 1504 N o .
50-345 Gruel Traverse Ave; 78-105 CALLE ESTADO
LA QUIN IA. CALIFORNIA 92253 tSV
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address
City ZipTel.
Corona X1719
Contractor
ress
ity jZip
State Lic. I City
& Class.if.$1+�6 Lic.
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm—that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 oftp a Busihess a io Professions Code and my license is in full force and
effect. �„AA S�—d. rv. _ . a /'e,
SIGNATURE.e Rte`^`'•. "'•f+/ {tis"! h f DATE
�' WN
OER-BUILDER'DDIfC,LARATION `
I hereby ffirm that I am exempt from the 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 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 dollars ($500).
❑ 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.)
❑'l, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Processions 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.)
❑ Tam 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
IKopy 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 the 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 forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number MLOAlftr_Ma
Legal Description Ornk HOMSS
Project Description its 1'n_
Sq. Ft. 2204 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
�SB.Qd
Plan Chk. Bal.
454..03
Const.
856.5O
Mech. -
79„00
Electrical
121.00
Plumbing
162.50
S.M.I.
11.34
Grading
Driveway Enc.
.Infrastructure
3623.34
TOTAL
5.557.72 5307.71
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 6/8/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING.FESS
1ST FL. SO. FT. ® $
UNITS
0444AB GRADE `
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. U
GAS (ROUGH) 790
DRAINAGE PIPING
CAR P. SD. Ff.
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT. @
TEMP. POLE
DRINKING FOUNTAIN
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
r
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 +
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
PLUMB. FEE
7-1
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
G OUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
0444AB GRADE `
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
v
SEWER QA
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF. U
GAS (ROUGH) 790
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)/ �� /�IvtL
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
FINAL INSP. 11 ,eQ-9p cu. yd.
$ plus x$
=$
LUMBER GR.
RAMING ?/0
FINAL INSP.
`Q
O0FING I _ �l ��C/
.1.1D
r
I , .
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL +
�k LATHING
MESH
G
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
►' '„ ""' Rte'-` , `" " ,, .; � -
,i BN FORM 116 L •'
t I BIA FORM 1466 11
I
INSULATION CERTIFICATIONr
l
This is to certify that in conformance with the current energy regulations (California Adminis-
trative
9Y 9
t; trative Code, Title 25, State of (alifornia) and approved plans, insulation has been installed in i ' •,
the building located at:
I
LA QUINTA RIVERSIDE
city County i �1
GRAND TRAVERSE AVENUE l0 25389
Street No. (It Available) Street Lor Number Tract No. 1)
DESCRIPTION OF INSTALLATION
ROOFS 1 it
Type of Material Manufacturer Thickness—R Value`s I p),
EXTERIOR WALLS OWENS CORNING 6 '/2 19
)
Type of Material FIBERGLAS BATI'S Manufacturer FIBERGLAS Thickness1-5L8'R Value** 13
(Or Trade Name)
CEILINGS 1211 38 I �'
BATTS: OWENS OQRNVING lit ,
Type of Material FIBERGLAS BATA'S Manufacturer FIBERGLAS Thickness s_R Value** 30 w
(Or Trade Name)
SQ. FL. Covered
i
BLOWN:
Type of Material Manufacturer Thickness No. Bags—
for
ags (Or Trade Nome) )
Wt./Bag SQ. Ft Covered R Value`* 1
FLOORS
Type of Material Manufacturer_
(Or Trade Name)
SLAB ON GRADE
Type of Material Manufacturer_
(Or Trade Name)
Width of, Insulation Inches
FOUNDATION WALLS (if required)
Type of Material Manufacturer -
(Or Trade Name)
REMARKS (if desired)
Thickness R Values`
Thickness - R Value**
Thickness—11 Values*
General Contractor (Builder) M J BROCK & SONS, INC. License Number
By Title Date
Sub-Contractor (Insulation Applicator) Accent Insulation Company License Number 274283
;
(Ittwlation, Mason tc.)
�(
(State -SAME" if same as t.cnenl tractor)
oo
By ;�� - -z Title Date 10-27-90
(•Califoen:e Administras:.e Cod*, Energy � ryy Maufot{oa Standards, dedons: EXCEIR k«n Sc. 19875 of the tl*alth and Safety Gds of IM Shale
"Comol:ance. iloen cemobl: en of IAe Installation Of insulation, a card of California.
coo4yina shot Mo insulofien Aar been installed in conformance—;t% the
(' rpulnmenh of these reovlo6ons shall b* completed and eaesured by "Ne ce"Ificole of Occupancy N similar gAificollot 11sot a •rely con-
: \ tA* 1-1.1;" eopllcoter and by the bvildar. This 1-sulat:on complionc* atract*d hotel, mot*l, aoartm*at haus*, hem* or dher resldwoiol
L \ cord shall be p*b*d of • conspicuous location -likia IM d-*IG,y.") d-*lliap Is habitable shall be iseved by such a building departmont
�i enloss IA* ahvcfvn at (*ase satisfies Ns* minimum energy lasulelioa
(••t Valve Is the measure *f the tetistanu of as material or Widins standards established p ravant to this chapter."
i I somoan*nl to the pmsoae of beat. Me resistoew .*two (*I of mass -type
insvlaliens shall not Include any value for teflocN.o faciea.l
tr j Form 116 —0 BUILDING NEWS, INC., 3055 OvedrW Ave., Los Angeles, Calif. 90OU-42131870-9871
Form 1486-0 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026-1213) 625-5771