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BLDG (0107-282) + BLCK (9816) + BLCK (5866)LICENSED CONTRACTOR 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 Code, and my License is in full force and effect. License # Lic. Class Exp. Date ,,5554,70 C39 QI�'32f2�, Date I .< f` G 'Sionature of Contractof-,•�-,' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&RC. for this reason Date Signature of Owner. WORKER'S COMPENSATION DECLARATION G lr I "hereby affirm under penalty of perjury one of the following declarations: O ( ) I have and will maintain a certificate of consent to self -insure for workers' K W compensation, as provided for by Section 3700 of the Labor Code, for the Qperformance of the work for which this permit is issued. n Q U ( ) I have and will maintain workers' compensation insurance, as required by j U QSection 3700 of the Labor Code, for the performance of the work for which this L rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It z Carrier Policy No. ob O NUMPT J (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issl.led, 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 3 subject'to the workers' compensation provisions of Section 3700 of the Labor Code, I shall'forthwith comply with those provisions. i Date: Applicant f ""`Warning: Failure•-to'secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ' 33 Signature (Owner/Agent) li `,7 f T/ Date BUILDING PERMIT PERMIT# DATEVALUATION LOT {FE07.2.82 TRACT ��,' I(�'w�e�r.�C3�,it%.i? JOB SITE `� APN ADDRESS OWNER / CONTRACTOR/DESIGNER/EN (NEER /t r M71TIRKERF W.YME I -DENS EW t";OAt'MIXTI:ON C-v1.PAt-TY 4 QI:JMTA. CA 92253 1=10 C.A. C92201 (-/60)776-0373 C.B7... 2201 USE OF PERMIT GEN11RAL BUILDING P_&ii',0QV CIAIS5 A AW. - Lr IA.LS CINLY A'U✓��4ile L' rTp�f��. WP �!W :rmnun'D Co`,S r oF C.'oPzonvenon 2..,7W" RBIR.00? M, 101-0004-18-000 _.. w S3R0(9 • . � f�,.F JUL 2 2001 }L_ --- LU11. t;l in F�?!inS(a : C[ ' ir'I I �Stf w'LY1?�° (111Ca1WIRi:Et.".`En09 AM) PLAN ij, � R_ J _. ____ CVIS UPAA�D EM $0.00 .p•� �y�. y gyp +y; v1•� 2 V'.,Rsd'1.6& .5 S.r.Ee.t4il.c►..i:,' :45ity ,2 Vi:S:+ J:i y'1 OO RECEIPT DATE �I ti (,/)/ °r BY DATE FINALED INSPECTOR INSPECTION RECORD ' OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Sle ' Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath* Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs - Electric Bond Footings Main Drain Brrnd Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances - Final COMMENTS: - Fir►jl + Utility Notice (Gas) - -_Z� ELECTRICAL APPROVALS Temp.' Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Pa6els Extorior:Receptacles G.FJ. -^ Smokd, Detectors TqM .4)se�of Power final] Utility Notice (Perm) - .••- ...... --.a +,ri.,. ' RP P---WqL rapasid Page No, of pani t u*s• rr.5fxrtian;u....._-._ aam• carr t State Lie. #555470 HENSLEY CONSTRUCTION CO. 83170 EMERALD AVENUE INDIO, CALIFORNIA 92201 (760) 342-4606 V.M. (760) 776-0373 4' q { G y 1 O ations JffP PrOP 9P hereby to furnish material and tabor — complete in accordance with above specificitiofts, for the suni of: dollars ($ ..I s to bU } } e made as S. - ` . 'Ail material Is awrantald to b► as tipaedred. All werk to be 40111010ted In a•WOMmanlikir .r manner aceerdlng to standard praobeea. Any *iteration or deviation f•cm above specific*. Authorised ' tions involving fair* costs will be executed only upon written ,orders. and will become an Signature ..�' eats eh&ae over and above thf estimate. All agreMntnts contmtant upon strikes, accidents or delays beyond our eorit/ol, Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be 01+r workers are luny covered by W*fkrneri s COMPOrlsst+on lnsulanct withdrawn by us if not accepted within dtya, AxartPtatur of Prix fixed — The above prices, apeciflcations and conditions are satisfactory and are hereby accepted, You are authorized Signature ter do the work as specified. Payment will be trade as Outlined above. Date of Acceptance: Signature r 1. r JffP PrOP 9P hereby to furnish material and tabor — complete in accordance with above specificitiofts, for the suni of: dollars ($ ..I s to bU } } e made as S. - ` . 'Ail material Is awrantald to b► as tipaedred. All werk to be 40111010ted In a•WOMmanlikir .r manner aceerdlng to standard praobeea. Any *iteration or deviation f•cm above specific*. Authorised ' tions involving fair* costs will be executed only upon written ,orders. and will become an Signature ..�' eats eh&ae over and above thf estimate. All agreMntnts contmtant upon strikes, accidents or delays beyond our eorit/ol, Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be 01+r workers are luny covered by W*fkrneri s COMPOrlsst+on lnsulanct withdrawn by us if not accepted within dtya, AxartPtatur of Prix fixed — The above prices, apeciflcations and conditions are satisfactory and are hereby accepted, You are authorized Signature ter do the work as specified. Payment will be trade as Outlined above. Date of Acceptance: Signature P.O. BOX 1504 9 916 Building 51460 Mendoza 7&105 CALLS Address LA QUINTA, CALIFORNIAORNIA 922153 / Owner Sandra Felski Mailing BUILDING: TYPE CONST. OCC: GRP. Address same A.P. Number atyLa Quinti Zip92253 Tel. Legal Description actor Contr�ialton masonry .�ts Project Description 72' of 51 block wall Address 50' of 6' block wall P. 0. Box 1771 City La Quinta Zip 92253 Tel.: 554-1799 State Lic. City & Classif. 591684 C29 Lic. # 1531 Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby,affirm that I am licensed under pro;ipns of Chapter 9 (commencing with Section 7000) of.Division 3 of the Business and Professions code, and my license Is in full force and electiF '�L°� t4 i'`a ?.L�iA' a� , , � J ' r SIGNATURE 1I DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 permitPlan subjects the applicant to a civil penalty of not more than rive 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. g, 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.) Estimated Valuation t, v 80 PERMIT AMOUNT Chk. Dep. Plan Chk. Bal. Const. 63.00 Mech. Electrical Plumbing ❑ 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.) ❑ I am exempt under Sec. B. & P.C. for this reason S.M.I. A n •40 Grading Driveway Enc. Date owner Infrastructure 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 crtopy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 63.40 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE REMARKS (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 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 ` ,, QQ.7,t.i,t+�..e�.,�,.,Q��.7""��, _, 10 Date Owner NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) Side Street Setback from Center Line Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR 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. Issued by: Validated by: Date Permit F Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SD. FT. WALL SQ. FT. SQ 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEWPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE ---jCONST. 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 REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIOWSOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL T4ht 4 4 Q" Building Address 51-460 Hendaaa Sandra A. Falske Mailing Address C City Zip Tel. La Quinta 92253 Contractor Liner/ Builder Address Tela State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address I Tel. CityI Zip I State Lic. # P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a Permit to construct, ater, improve, dernoish, or repair any structure, pilot to its issuance also requires the appficard for such permit to ft a signed statement that he is licensed pursuant to the provisions of the Contractors 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 exemlAion. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a dvipenaty o/not more than five hundred dollars f$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 Conbac 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 brprovements are not intended or offered for sale. If, however, the building or improvement is sold wthfn one year of completion, the owner -builder will have the burden of proving that he did not buil or rrprove for the purpose of sale.) ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not appy 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 Sea B. & P.C. for this reason Date f " ' Owner WORKED' COMPENSATION DECLARATION I hereby affirm that 1 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 ❑ Copy 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.) 1 certify that in the performance of thg work for which this permit is issued, 1 shall not employ any person in arty, manner so as to become subject to the Workers' Compensation Laws of California Date owner / NOTICE TO APPLICANT: t: after mak ng,-this-C&Iffmcate of Exemption you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provf =m or this pemnit shag 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, Ciw7 Code.) Lenders Name Lenders 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. 05866 BUILDING: TYPE CONST. ' OCC: GRP.: A.P. Number 773-102-0" Description t Description T-T^.,rT Vwft,.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 INSPECTOR Issued by: Date6-13'89 Permit Validated by: Validation: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ L - Estimated Valuation 510.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 25.OU Mech. Electrical Plumbing S.M.I. . �] Grading Driveway Enc. Infrastructure TOTAL REMARKS t I, 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: Date6-13'89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SO FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING: 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. SQ. FT. ® c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL 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 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 APPJEQUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND GRADING /FINISH CEINAL INSPECTIO a2 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 1