0202-307 (DEMO)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
442118 B L '3tDiZt
D `tet / . Signature of Contractor `- r•� s
�1--, k�
OWN ER -B UI LDEWDECLARATION�
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&P.C. for this reason f
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarationsv
( ) 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
Irpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier RXEM PT Policy No.
(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 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 complyr.with those provisions.
Date:_ ApplicanE _ �f
Warning: Failure to secure'Wo kers' Comp nsatio • coverage is unlawful and
shall subject an employer to'criminal penalties and cdiiIl 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
At
the above-mentioned property for inspection purposes.
r I.'� f
Signature (Owner/Agent)., •• -Ile r �DateL -s
BUILDINS-PERMIT PERMIT#
DATE I VALUATION LOT TRACT
fr
S1110 3 LOGE
JOB SITE
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
w
mu.. 8aU=1gGER
l.,t+,..LO:l+ N, EDYCOA13T CO.
7 8-021VAR T', ICUM �
48.751 SM I'EDIR0 V'r'i EST
CA 92253
LA,.Qj)1krj'A CA. 92253
V60)564-4660 CBVJ 469
USE OF PERMIT
111-01 40111TION
k2rM+1)1.JTION Pifiti P&PROi ET) FLAW, PRIOR TO PX.M Dff7 d..A1)DYV102I.
FISTMATED COST OF CONISTRUMION
TWO
MtMi<'.i MS 99MV.I'ARY I
DritiU%.#TION FR_V 101.000.42340 S45.00
Ee"L1 U
Pv,'jAR
CITY0FL.Ad111&1*
- F&'�ANMWT
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LF493 P It -PAW MIS
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TOTAL ]PERMEr Ir'FAS ]) UE if
$455R D
RECEIPT
DATEj/
By -
�_
INSPECTOR
N
INSPECTION RECORD
J
OPERATION I DATE I INSPECTOR OPERATION I DATE I INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
0. K. to Wrap F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans 8 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
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I 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
11111 Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
' Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Tp: Tom Kennedy
,i
Estimator: Erik Schucnard
Page 1 of 2 2/11/02
02/08/02
�- CDo n,
CITY OF LA QUINTA
DEPT.
BUILDING & SAFETY
I)E11\401ATION, INC.,
APPROVED
3634 Haur1•d Ave.
FOR CONSTRUCTION
SANTAANA, CA 92703
(71.1) -554-5291
FA\ (71) 554••5292
6� BY
ATE
Lic. #758633 - C-61, C-2 t, C-12, DO
JOB
TOTAL PRICE 1 "
Schlesinger Residence
$12,500:00
78-023 San Timoteo St.
La Quinta, CA.
SCOPE OF WORK
1
Remove existing overhangs & patio covers
990 S.F.
2
Remove existing glass sliders
480 S.F.
3
Remove existing stucco to stud
600 S.F.
4
Remove existing vinyl
735 S.F.
5
Remove existing carpet and pad
1715 S.F. .
6
Remove existing drywall to stud
1525 S.F.
' 7
Break and remove existing concrete @ fireplace
24 S.F. -
8
Break and remove existing patio deck
461 S.F.
9
Break apd remove existing pool.deck
1240 S.F.
10
Wallsaw, break, and remove exterior wall @ front yard.
480 S.F.
11
Break and remove rear yard property wall
193 S.F.
12
Break and remove rear yard house block wall @patio
64 S.F.
13
Break and remove rear yard property footings
35 L.F.
14
Break and remove rear yard house footings @ patio
8 L.F.
15
Break and remove existing footings front yard
80 L.F.
16
Break and remove existing columns
(2) 8 X 2
17
Remove existing trees
4
18
Remove interior millwork
19
Remove existing vegitation
EXCLUSIONS
(except as noted above)
1
Protection of existing finishes and improvements to remain
��
Spectra'
't
NOUC:E OF COMPLETION
MARC.i.-]: H., 2002
AVIN: V : TO.M KENNEDY
COPANY: T.A. KENNEDY CONSTZtIJC'J'IO
AMN
ADDRESS: 48-751 SAN PED.RO.
LA QUIN'TA, 92253
PIIONE: 760-564-4660
FAX: 760-564- 4660
JOB #: 2118
JOHSITE: 7803 SAN TIM07`EO
LA QUIN'T'A, 92253
On March 11, 2002 Spectrum. Abatement ,pe-rforn):d .ren.xva] of asbestos
.containuig material at the-a.forenieut.ioDed site..
Alt wozk was performed iii. accordance tvi.tb. F,aderal, State az.).d ]oval regulations.
If you Dave auy questions, or need any further assistance, please Contact me.
Sincerely,`
r
784
Rick. M.iraw.omes
NarthLemon Street Projects Manager
SPectrwi Abatement
AA
Orange, Ca4f01ma
92887 ' -
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71a.7Ji0a01tas .
www, ashosta3-mmmal.com
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Apectru . a���r.m��t
784 N. Lemon -St:
Orange, CA 92867
Inv
oic,e
Date Invoice #
3/8/2002 2118