06-1265 (RR)4rI---
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00001265
54410 AVENIDA VELASCO
774-252-008-8 -000000-
RE-ROOF
COVE RESIDENTIAL
3200
Architect or Engineer:
P /P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION f
1 hereby affirm under penalty of perjury that 1 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 Class: B -C39 License o. 555470
Coate: " ontractor: /
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's 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 Contractor's 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
.C?any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1 '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 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.).
(_ 1 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.).
(_ I I am exempt under, Sec. , B.&P.C. for this reason
Date: Owner:
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:
Lender's Address:
LQPERMIT
Owner:
LYNDON FRANZ
54410 AVENIDA VELASCO
LA QUINTA, CA 92253
Contractor:
HENSLEY CONSTRUCTION, MARVIN
83170 EMERALD AVENUE
INDIO, CA 92201
(760)902-2600
Lic. No.: 555470
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I
Date: 3/29/06
MAR 3 0 2006
CITY OF LA QUINTA
WORKER'S COMPENSATION DECLARATION
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 EXEMPT Policy Number EXEMPT
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 t e Labor Code, I shall forthwith co:*1nose provision n
atPl e: �� ® cant: /✓� vyi� T j
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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.
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. 1 agree to comply with all
city and c ty ordinances and state laws relating to building construction, and hereby authorize representatives
of his
unntty to en/te1r upon the a -mentioned property for inspection pulposes. /
Oa e:,7 ^• ✓ Silure (Applicant or Agent):
Application Number . . . . 06-00001265
Permit . . RE -ROOF
Additional desc .
Permit Fee. 30.00
Plan Check
Fee
.`00
Issue .Date
Valuation'
. . .
. 0
Expiration Date .. 9/25/06
Qty Unit Charge Per
Extension
-BASE
-
FEE
30.00
------------------------------------
Special Notes and Comments
-----------------
------
---------------
' RE -ROOF WITH COMPOSITE SHINGLES,
CLASS.
"A" MATERIALS
°
[A Fee summary Charged.
Paid Credited
Due
-Permit Fee Total" 30.0.0
.00
.00
30.00
Plan Check Total 00
.00
00
- .00
Grand Total 30.00
..00
.00
30.00
Pam
t'aga NO. of
State Lit:. #555470 HENSLEY CONSTRUCTION CO.
83170 EMERALD AVENUE
INDIO, CALIFORNIA 92201
(760) 342-4506
V.M. (760) 776.0373
SUMMED `"`
DATE
TRE T r
B E
CITY. ATE ANO PCO
1. �+G•
."a um -n
ARCHITECT DATE Of PLANS
JOa PHONE
We hereby submit specifications and estimates for;
I ff WWW � �s
NfirvV05P hereby to furnish material and labor — complete in accordance with above specifications, for the• sum of:
0_0eco--o
dollars ($
to ba made Islo S.
'All material is guaranteed to be as specified. An work to be completed in a•workmanlike
manner aCCOMurig to Standard practices. Any alteration or div stion form above specifics. Authorized ilk
tions involving extra costs will be executed only upon written orders, and will become an -Signature
extra charge over and above the estimate. All aateamionts contingent upon strikes. accidents '
or delays tiayond our control. Owner to carry fire. tornado and other necessary insurance. Note: This proposal may be
01-, workers are fully covered by workmen's Corrpensaven insurance withdrawn by us if not accepted within day's.
1,rrmimt at 11rppDsil —The aoove prices, specifications
and conditions arc satisfactory and are hereby accepted. You are authorized
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance.
Signature
Signature
1
�M A., AA I -M,&
Bin #
�>
City of La Quinta' '
Building U Safety*Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building'Permit Application and Tracking Sheet
Permit #
Project Address: S
v •
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip;
Contractor:
Telephone,
z
Address:1-70
Hyl4�1
Project Description:
City, ST, Zip:
,
Telephone: p
15 L)
O
T
gr> e3
State Lie. # :
7 6
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
'
Telephone:
State Lie. #:
Name of Contact Person:
�'
'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair .Demo
Sq, Ft.:
#Stories:
#Units:
Telephone # of Contact Person:o
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
1
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees