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12300 (BLDG)Building 48-110 Calle Seranaa Owner Mr. a Mrs. Polensky P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address SAMO City Zip Tel. La Qui.nta, CA 92253 564-2757 iMIN54Drewe construction U if ll. Sari Rafael Itoad . City Zip Tela Palm Springs, 1 922662 3228872 State Lic. B 141952 City LAK L� & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSEDICONTRACTOR'S DECLARATION I hereby affifmw hat I,am licensed under provisions of Chapter 9 (commencing with Section � ,s7000) Of Division•3-df the Btisingssland Professions Code, and my license is in full force and J stGNATURE tf1�A_l` r DATE OWNER -BUILDER DECLARATION I hereby affirm 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 file a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 or 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. If, however, the building orimprovement 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 or sale.) ❑ 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 .Copy is filed with the city. O 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 or the Labor Code, you must forthwith comply with such provisions or this permit shall 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, 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 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 sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 12300 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Drywall and insulation renai Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 04s3!JOU.UV PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. rvr •J Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL �• /� 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 IN CTOR Issued by: Date Permit Validated by: SEP 21 1993 Validation: 661 I\ , ; CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS • 'v BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. WALL SO. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ plus x$ =$ URINAL SO. FT. ® FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation 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 LAUNDRYTRAY AIR HANDLING UNIT CFM 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER A6POeFINAL INSPECTIO 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 APP.IEQUIP. 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 Ste` REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING A6POeFINAL INSPECTIO CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ' HOLTGREWE CONSTRUCTION, INC. y .`P.O. Box 20.45 Palm. Springs, 'CA • 92263-2045 .(619)_322-8872 State tic. #s 141952, 658424 'ASSIGNMENT SHEET ` Job #1158--A Estimator' :Herb Wilson Print-out Datei :09/21/93 CUSTOMER' JOB LOCATION William & Helen Pelensky 1828 114th Street 48110 CalleSerans Edmonton (Alberta), CN ?6J4V1 La Quinta., CA 92253 H/PH :('403)= 436-7494 Fax - (619) 564=2767 Fax B/PH :( ) - 341-1181 (Same) same INSURANCE COMPANY Farmers Insurance:Group -POLICY # P.O. Box 13.26 CLAIM # :K657455 Rancho Mirage, CA 92270i'- DATE OF LOSS :07./23/93 (619) 346=0051 Fax (619) 340-1354 DEDUCTIBLE :250.00 Adj: Steven`Sorensen TYPE OF LOSS :Water J MORTGAGE COMPANY ' ( ) Fax ( ) Loan # _.. SPECIAL INSTRUCTIONS Provided emergency water extraction services, including removal, of soaked padding & delaminated carpet & removal'of mildew. -drywall`: End Of Report ********** HOLTGREWE CONSTRUCTION,.INC. ' P.:O. Box •2045 Palm Springs, CA 92263-2045 (619) 322-8872 State Lic. #s 141952, 658424 STRUCTURE SCOPE SHEET Name William-& Helen Pelensky: Job # 1158--A Date Printed : 09/21/93 Page 1 ----------------------------------------------------------------------------- # Code Description U/M #/U. Area Name Living Room 271611-x 15111" x 1110" . 1 37118 U Window Blinds -.Detach & Reset EA 3.00 2 37119 U 'Draperies/valences - Detach.& Reset. EA 3::00 3 10639 U HVAC Grill - Detach & Reset..(EA) EA, 1.00 4 120.93 U Scrape & Seal Stud Wall for Odor SFS 347.36 Control. 5 05009C Disinfect-inject/spray-heavy SFF 437.71 6 20004 Craft faced fiberglass R-11 insultn SF 127.36 to 4' on 2 -short walls 7 13001 U Install 1/2" drywall -walls -textured SF 347.36 ready for paint walls to 41 at perimeter 8 108003U Baseboard 2 1/4" PER 86.83 9. 10899.9 Rebuild wooden window sill EA :2.00 10 12002 U Paint 2 coats -walls (Seal & Paint). SFW 955.17 it 12081.0 Mask & prep,for paint PER 86.83 12 16040..Repair ceramic tile -minimum charge M/C .1.00 at fireplace - regrout,' as needed 13 03605C Acid wash ceramic the floors-hvy SF 50.00 6x6 area at entry & 14SF at FP 14 01359 U R/R Carpet - High Grade SYF 53.49. 15 01402 1/2" 5�lb. rebond padding S.YF 48.63 16 05017 U Thermafog w/ Malgon SFF 437.71 Area Name Hallway 9'011'x 319" x 71011 Offset ' W 3' 311-x D 3' 3" x H' 71, 0" (+) Offset Closet W 5' 8" x :D 2' -4" x :H 7' 0" (+) Offset Laundry. W . 51. 0" x D 2' 911. x H 7' 0" (+) 1 02208 R&R.Clothes washer. EA 1.00 2 02209 R&R Clothes dryer, EA 1.00 3 02001B Remove linoleum from concrete floor SFF 47.50. .4 12093 U Scrape & Seal Stud Wall for.Odor SF 147.59 Control STRUCTURE:.SCOPE.SHEET Name , : William &' Helen Pelensky_ Job # °: 1158a --A Date Printed 09/21/93 :.Page 2:,' # . Code - -------------------------------------------------- Description U/M #/U 5 05009C Disinfect-inject/spray-heavy SFF 33.75 " 6 13001 U Install,1/2" drywall -walls -textured SF 147.'59 ready for paint walls to 41 -at - ' at.perimeter perimeter, 7 108003U Baseboard 2 1/4" PER 42.17. -8 108001U Shelving 16" in"place (R%R)- LF 120.00 9 12002 U Paint 2 coats -walls (Seal &,-Paint) SFW 295.17 10 120811U Mask & prep for paint PER 42•.17 11 12096 U' Paint Bifold Closet Door Set (Side) EA 2.00. 12 12084 U Paint - Shelving 16" wide LF 120.00 13 02002C Prep floor for linoleum -heavy SFF 47.50 14- 02004 U '. Linoleum - Laundry room SY 2:00 15 02003 -Labor to install linoleum SYF 5:28 16 01402 -1/2"'5 lb.-.rebond padding SYF 6..39 17 01359 U R/R Carpet.- High Grade SYF 7.03 .18 05017 U Thermafog w/ Malgon SFF 7,1.28' Area Name Bedroom 12'0." x'11'0" x.8'0" Offset Closet W .7' 0" x D 2' 9" x H 8 0" (+) 1 37118 U Window Blinds - Detach & Reset EA 1.00 2 37119 U Draperies/valences - Detach &.Reset EA 1.00 3 12093, U Scrape. & Seal Stud Wall for odor*. SF 206.00 Control 4 06009C Disinfect-inject/spray-heavy SFF 151.25 .5 20004 Craft faced fiberglass R-ll.insultn SF -103.00 to 4'.6n 1 long & 1 short wall 6 13001 U Install 1/2" drywall -walls -textured '' SF 206.00 ready for paint walls to.41'at perimeter 7 108003U Baseboard 2 1/4" PER 51.50 8 108999 Rebuild wooden window sill. EA- 1.00 9 918055-U Refit -boor & Jamb EA 1.00 10. 12011 U. Paint Door (both sides 1 color) EA 1.00 11 12002 U Paint 2 coats -walls (Seal &'Paint). SFW 412.00> 12 -1,2081 .0 Mask & prep . for paint PER 51.50 13 01359 U R/R'.Carpet - High Grade SYF 18.49 14 01402 1/2" 5 lb.. rebond padding SYF 16.8.1 15. 05017 U Thermafog w/ Malgon SFF 151.,25 STRUCTURE SCOPE SHEET Name :.William & Helen Pelensky Job # : 1158--A..,, Date Printed : ------------------------------------------------------------------------------ 09/21/93 Page # ------------------------------------------------------------------------------ Code Description U/M #/U Area Name Bath 8'0" x 51011 x 810" - Offset. W 3' 0" x D 2' 4" x H r 8' 0'! (+) 1 12093 U Scrape & Seal Stud Wall for Odor SF 122:66 Control 2 05009C Disinfect-inject/spray-heavy SFF 47..00. 3 20004 Craft faced fiberglass R-11 insultn SF 32.00 ,. to 4' on 1 long wall 4 13001 U Install 1/2" drywall-walls-texttred SF 122.66 ready for.paint walls to 4" at perimeter 5 108003U Baseboard 2 1/4" PER 30.67 6 15023 Reinstall vanity/top/sink & repair L/S` 1..00 to vanity base.& toe kick, includes seal & paint - in & out 7 21009 Plumbing labor HRS 1.00 8 19010 Mirror Installation - 1 man SF 15.00 9 18055 U Refit Door & Jamb - EA 1.00 10 12011 U Paint.Door.(both sides 1 color) EA 1.00 it 12002 U Paint 2 coats -walls (Seal & Paint) SFW 245.13 12 12081 U Mask & prep for paint PER 30.67 13 02001B Remove linoleum from concrete floor „SFF 47.00 14 02002C Prep floor for linoleum -heavy SFF 47.00 15 02003 Labor to install linoleum SYF 5.22 16 02004 U Linoleum SY 5.74 17 05017 U Thermafog w/ Malgon SFF. 47.00 Area ,Name Kitchen 1416" x 10'0",x 8'0" Offset W 9' 0" x D 4' 6" x H 8' 0" (+) 1 37118 U Window Blinds-- Detach & Reset EA 7:00 2 37119 U Draperies/valences - Detach & Reset EA 7:00 3 12093 U Scrape & Seal Stud Wall for Odor, SF 268.00 Control 4 05009C Disinfect-inject/spray-heavy SFF 185.50 5 20004 Craft faced fiberglass R-11 insultn SF 134.00 to 4' on 1 long & 1 short wall .. 6 13001 U Install 1/2" drywall -walls -textured SF 268.00 ready for paint walls to 4' at perimeter STRUCTURE SCOPE SHEET Name : William & Helen Pelensky 'Job # : .1158--A. Date Printed : 09/21%93 Page 4 # Code Description U/M #/U 7 108003U Baseboard'2 1/4" PER 58.00 8 15023 Remove/reinstall/top/sink & disposa HR 22..00 Repair to cabinet base& toe kick 9 21009 Plumbing labor HRS. 2.00 10".02213 R&R.dishwasher EA 1.00 11 02214 R&R trash compactor EA 1.00 12 12073 Strip, sand & refinish base cabinet LF 21.50, 13 12073 Strip,' sand &' refinish .face frame LF 4.00 of dishwasher & trash compactor 14 16003A Ceramic coving (backsplash) LF 16.75 15- 16001 Install ceramic counter.top.to 27" LF 16.75 16 18055 U Rebuild wrapped/cased door opening EA 1.00 17 12002 U Paint ,2 coats -walls (Seal & Paint) SFW 464.00 18 12081 U Mask & prep for paint PER 58.00 19 02001B Remove linoleum -from concrete floor SFF 185.50 20 020020 Prep floor for.linoleum-heavy SFF 185.50 21 02003 Labor'to.install linoleum . SYF 20.61 22 02004 U Linoleum 22.67 23 05017 .0 r Thermafog w/ Malgon ksy SFF 185.50 Area Name Hall 6'8" x 61'3" x 7'0" 1 12093 U Scrape & Seal Stud Wall for Odor SF 103-04 Control 2 05009C Disinfect-inject/spray-heavy SFF 41.67 3 13001 U Install 1/2" drywall -walls -textured SF 103.34 ready.,for paint walls to 4' at . perimeter 4__ 108003U Baseboard1/4" PER 25.83 512002 U .2 Paint 2 coats -walls (Seal & Paint) SFW 180.83 6 12081 U Mask & prep for paint PER 25.83 7 15023 Repair cabinets -minimum charge M/C 1.00. to linen closet w/ 4 doors & 6 shelves - repair as needed. ..8 16014 Regrout floor tile at linen closet HR 2.00 9 03605C .Acid wash.ceramic tile floors-hvy SFF 41.67 10, 05017 U Thermafog w/ Malgon SFF 41.67 STRUCTURE.SCOPE SHEET Name.: William & Helen Pelensky Job # 1158--A Date Printed :.09/21•/93 -------------------------------------------=---------------------------------- , Page 5 # Code 'Description U/M #/U Area Name: Den 1119" x 1110" x 8'0" Offset Closet #1 W' 3' 01" _x D 2' 4" x H 8' 0". (+) Offset Closet #2 W 3'-'0" x D 21''411.x H .8' 0" (+) Offset Wet *Bar W 4' 3" x D 12.' 4" x H 8' 0" (+) 1 37118 U Window -Blinds - Detach & Reset EA 1:00 2 37119 U Draperies/valence- Detach & Reset s EA 1..00 ,3 12093 U Scrape & 'Seal Stud Wall for Odor SF 238.00 Control 4 05009C Disinfect-inject/spray-heavy SFF 153.17 5 20004 Craft faced fiberglass R-11 insultn SF 119.00 to 4' on 1 long &,.1 short wall 6 13001 U Install 1/2-" drywall -walls -textured SF, 238.00 ready for -paint walls to 41'at perimeter 7 108003U Baseboard 2 1/4" PER- 59.50 .8 15023 Reinstall wetbar/top/sink & repair L/S 1.00 to vanity base &-toe kick,, includes refinishing same 9 108999 Rebuild wooden window sill EA 1.00 10 21009 Plumbing labor HRS 1.00 11 18055.0 Refit Door & Jamb -•1 pair of dbl EA 4.00 entry. doors & 2. each closet doors 12 12011 U Paint Door (both sides 1 color) EA 4.00 13 12002 U Paint 2 coats-walls.(Seal & Paint) SFW 476.0.0 14 12081 U Mask & prep -for paint PER 59.50 . 15 01359 U_' R/R Carpet - High Grade SYF 18.72 16 01402 1/2"_5 lb. rebond padding SYF 17.02 17 05017 U 'Thermafog'w/ Malgon' SFF 153.17 . Area.Name Master Dressing. 616" x 610" x 8'0" Offset -Closet W :6' 0" x D• 2' 6" x H 8' 0" (+) 1 12093 U Scrape &-Seal Stud Wall, for Odor SF 120.00 Control 2. 05009C Disinfect-inject/spray-heavy SFF 54.00 .3 20004 Craft faced fiberglass R -ii insultn SF 26.00 to 4' on 1 long wall 4 13001 U. Install 1/2" drywall -walls -textured SF 120.00 ready fo`r paint walls to 4' at perimeter STRUCTURE SCOPE SHEET .Name,: William &- Helen Pelensky Job # 1158--A Date Printed ---------------------------------- 09/21/93 --------------------- Page -6 . #., ------------------------------------------------------------------------------ "Code ----------------------- Description U/M #/U 5 15023 Reinstall vanity/top/sinkk& repair L/S 1.00 to vanity base &'toe kick, includes.. seal & paint - in..& out 6 21009 Plumbing labor HRS 1.50 7 19010 Mirror Installation --1 man SF 19.50 8 15023 Repair cabinets -:minimum charge M/C. 1.00 to linen closet w/ 4'doors & 6 shelves - repair as needed 9 10800lU Shelving 16" in place (R/R) LF 6.50 10 12084'U. Paint- Shelving 16" wide LF 12.00 it 108003.0 Baseboard 2 1/4" PER 30.00 ., 12 12002'U Paint 2 coats -walls (Seal & Paint) SFW 240.00 13 12081,U Mask &-prep for paint PER 30.00 14. 01359,U :R/R Carpet -.High Grade SYF 6.60 15 01402 1/2" 5 lb. rebond padding SYF '6.00 16 05017. U Thermafog w/ Malgon SFF 54.00 Area Name Master Bath 810" x .610'11,x 8'0" 1 '108003U Baseboard 2,1%4!' LF 28.00 2 12002'U Paint .2 coats -walls (Seal & Paint) SFW: 22,4.00 3 120.81 U . Mask & prep for paint. PER 28.00 4 18055 U Refit Door & Jamb EA 1.00 5 12011.0 Paint Door (both sides,l color) EA 1.00 6 01359.0 R/R Carpet - High Grade SYF 5.86 7 01402. 1/2" 5 lb. rebond padding SYF 5.33 8 05017 U Thermafog w/..Malgon SFF 48.00 Area Name Master Bedroom 1516" x 141001.x 9'0" Offset Closet , W 9' 0" x D. 7' 0" x H- 70' 0" (+) 1 37118 U Window Blinds - Detach'& Reset EA i.00 2 37119 U Draperies/valences -'Detach & Reset EA 1.00 .3 12093 U Scrape & Seal Stud Wall for Odor SF 285.00 ' Control 4 05009C Disinfect-inject/spray-heavy SFF 280.00 5 20004 Craft faced fiberglass R-11 insultn SF 118..00 to 4' on 1 long & 1 short wall . 6 13001•U Install.1/2" drywall -walls -textured. SF 285.00 ready for paint walls to 4' at perimeter. STRUCTURE SCOPE SHEET Name William &'Helen Pelensky. Job # s'1158 --A Date ------------------------------------------------------------------------------ Printed 09/21/93 Page 7 # Code Description U/M - #/U 7 108003U Baseboard_2 1/4" PER' 73.00 8 18055 U Refit Door'&.Jamb EA 1.00 9 12011 U Paint Door (.both sides 1 color) EA 1.00 10 12002 U. Paint 2 1coats-walls (Seal & Paint). SFW 629.00 it 1.2081 U Mask & prep for paint. PER 73.00 12 01359.0 R/R Carpet - High Grade SYF 34.22.- 13 01402 1/2." 5 lb. rebond padding SYF 31.11 14 05017 U Thermafog-,w/ Malgon.' SFF 280.00 Area Name Exterior 1 03503A Pressure wash concrete -light SF 846.00 4 pads in'r.ear: 14x16; 15x18; 14x16;8x16 2 03605C Acid wash ceramic tile,in front SF 161.00 i entry: 5x7 & 9x14 Area Name General 1 10801 Permits TOT 1.:00 2 10008 U Clean-up & Haul..Away Debris EA 1.00