RR (04-6591)51771 Avenida Martinez
04-6591
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OF LAQUINT ► BUILDING & SAFETY DEPARTMENT
4ZAA'EPT.._
Box 1504 (760):777-7012
OF49 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT .
Application Number . . 04-00006591 Date 10/04/04
Property Address . . . . . . 51771 AVENIDA MARTINEZ
APN: 773-175-025-2 -000000-
Application description . . . RE -ROOF
Property Zoning . . .. . . COVE RESIDENTIAL
Application valuation . . . . 3500
Owner Contractor.
-------- .--------------- -- - ------- - - ---- ,
GARCIA THOMAS` P ' HENSLEY 'CON'STRUC.TION, MARVIN
51771 AVENIDA MARTINEZ. 83170 EMERALD AVENUE
LA QUINTA CA 92253 INDIO CA 92201
(760) 902-2600
WCC: EXEMPT
WC: EXEMPT 10/31/05
CSLB: 555470 01/31/05
CCC:' B -C39.
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Permit RE -ROOF
Additional desc .
Permit Fee 30.00 Plan Check Fee'. .00
Issue Date . . . . Valuation 0
Expiration Date 4/04/05
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------- ------------------
Special Notes and Comments
RE -ROOF WITH CLASS "A" MATERIALS
Fee summary Charged = Paid 'Credited Due
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00 00 .00 .00
Grand Total 30.00 .00 .00 30.00
4
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-701 1
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: /0' Z4 -O
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.: t 14
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Cod d my Lice is in full or e'aect. �SS
cense Class ff�7 r Lice V
i
OWNER -BUILDER DECLARATION
I hereby affirm nder penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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).):
U 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,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
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, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES U TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
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 county to enter upon the above-mentioned property for inspection purposes.
ate 6 ignature (Applicant or Agent): I
--- _ Brod ,gal ...- Page rte. orpan
State Lic. 9555470
'
HENSLEY CONSTRUCTION CO.
83170 EMERALD AVENUE
INDIO, CALIFORNIA 92201
(760) 342-4506 -
V.M. (760) 776-0373
PROPOSAL 1Waatig To
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CITY. STATE O 21 coo
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• JOB LOCATIOM
ARCHITECT
DATE OF PLANS
JOa PHONE
We hereby submit specifications and estimates for:
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OPf1rupoBP
Payment to be made as torso
hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
0 -
dollars ($
'All mateviat is guaranteed to be as specified. An work to be compieted in a•woMmanlike
manner aceonbrte to standard practices. Any alteration or dev-ation from above specifics•
tions irwolvina extra costs will be tetcutod only upon written orders. and will become an
extra ch"t over and above the *$timet*. All agreements contingent upon strikes, accidents
Or delays beyond Our Control. Owner to carry fire. tornado and other necessary insurance.
01. "Wiwi are fully covered by workmen's Compensation insurance
Arr> pima of 11raaposal —The aoove prices. specifications
and conditions are satisfactory and are hereby accepted. You are authorized
tir do the work as specified. Payment will be made as outlined above.
Date of Acceptance:
Authorized
Signature
Note: This proposal may be
withdrawn by us if not accepted within days.
Signature
Signature