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BRES2015-0119fir. • Q�i uut,%v 78-495 CALLE TAMPICO U .. LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Applicant: JULI HAFDELL 78550 AVENIDA TUIUNGA LA QUINTA, CA 92253 ---------------- 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 Professions Code, and my License is in full force and effect. License Class: License No.::CONV. 40528101254087838 Date ContracttVA OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars WI, es 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 or she did not build or improve for the purpose of sale.). 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 tNContractors' State License Law.). (_) I am exempt under. Sec.. . B.&P.C. for this reason Date: t -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: VOICE (760) 777-7125. FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/28/2015 Owner: JULI HAFDELL 78550 AVENIDA TUJU NGA.. LA QUINTA, CA 92253 �J Application Number: BRES2015-0119 Property Address: 78550 AVENIDA TUJUNGA APN: 770091010 Application Description: HAFDELLJULI REMODEL Prop erty.Zoning: z Application Valuation: $10,000.00 Applicant: JULI HAFDELL 78550 AVENIDA TUIUNGA LA QUINTA, CA 92253 ---------------- 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 Professions Code, and my License is in full force and effect. License Class: License No.::CONV. 40528101254087838 Date ContracttVA OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars WI, es 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 or she did not build or improve for the purpose of sale.). 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 tNContractors' State License Law.). (_) I am exempt under. Sec.. . B.&P.C. for this reason Date: t -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: VOICE (760) 777-7125. FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/28/2015 Owner: JULI HAFDELL 78550 AVENIDA TUJU NGA.. LA QUINTA, CA 92253 �J z w Q �o 0U�Zz z Contractor: � z JULI HAFDELL o 78550 AVENIDATUIUNGA (illLA QUINTA, CA 92253v z (7.60)771-4066 `:—'� o Llc. No.::CO NV:140528101254087838 ---------------------------------------------- WORKER'S 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: cert I ify 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. Date: Al J Applicant: JAI l.t'Fdfi 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'ACKN OWLEDG EM ENT IMPORTANT: Application is hereby made to the Building Official 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. 4 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 upon the above- mentioned property for inspection purposes. Date: II 18 15_ Signature (Applicant or-Agent):.�v�c FINANCIAL INFORMATION t = r ADESCRIPTION +r s�ACCOUNTQTY�AMOUNTh M 77 gPAID DATE .. kTFPAID7�x BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 x PAID:BY �; " r �� - METHOD' CHECK# n::CLTDBY ,.. ;RECEIPT+# - $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION BSAk $1:00 r ,, .: � DESCRIPTION.. , ,ACCOUNT � ;. 1, � ' 3QTY,; 4'.` ',AMOUNT:'.,. c. 4 PAID PAID DATE; y DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 ',,PAID BY � +r s METHOD f :, RECEIPT # " � y, CHECK #F U ' i CCTD BY ; 3 `.` DESCRIPTIONS £ a+x� ACCOUNT z :'QTY wz AMOUNT ~�y PAID,'*' PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 `PAIDBY h METHOD , ' "£RECEIPT CHECK # CCTD BY a. _+ 9 -W+f. <:r, $0.00 Total Paid for ELECTRICAL: $48.34 .,::DESCRIPTION: ,:. ACCOUNT QTY . w_A�IAOUNT f PAIDf _ ` z PAID DATE= FIXTURE/TRAP t 101-0000-42401 0 $48.36 $0.00 PAID BY 5 "� METHOD x`{ �, ;: RECEIPT # x CHECK # u CCTD BY PAID PAIDDATE:' x w `DESCRIP,TION ACCOUNT .m x,,.� QTY AMOUNT y ` F FIXTURE/TRAP PC 101-0000-42600 •0 $48.36- $0.00 PAID BY ¢ F . METHOD F ¢ r RECEIPT # ` :. f ' " ,CHECK # � �� i� CT BY PAID .'k PAID, DATE ^R . 'DESCRIPTION ACCOUNT QTY � AMOUNT :, n - , „ WATER SYSTEM INST/ALT/REP 101-000042401 ' 0 $12.09 $0.00 PAID BY METHOD ► ''•RECEIPT #..� CHECK # 'CCTD BYE; t .k _PAIDs I . „ .PAID DATE- DESCRIPTION . , & i. i "ACCOUNT k+ t;Z sQTI(: i4MOUNT t' z - . • WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09. $0.00 Y .�. > r t. .F - , 44 _. BYMETHOD ' tkM! ': -' . f.-. S.. -- .. i. YM .. RECEIPT #r + w CH # ' ECK u• 'CLTD BY ,PAID $0.00 _ Total Paid forPLUMBING FEES: $120.90 DESCRIPTIONa ' s+ i' tACCOUNT ,, QTY' a ;: " 'PAID PAID DATE ,._ x, . ... . .'AMOUNT:'r _ .f, , REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $21.75 $0.00 p PAID. BY a a METHOD ' ' F RECEIPT # CHECK # CCTD BY r r PAID tPAID DATE DESCRIPTION fl ` ° ; : ` i ACCOUNT E, :' CITY' ?°AMOUNT`^� x REMODEL; EA ADDITIONAL 500 SF PC "' 101-0000-42600 0 $17.40 $0.00 PAIDByET MHODF+'.;'F `< RECEIP;T # ' • CHECK PAID PAID DATE " DESCRIPTION r > s 'ACCOUNT ,;`: ' , i QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400• 0 $49.31- $0.00 PAID BY CHECK W, CLTD BYE. Ia, F r e'DES3CRIPTION„� ' Q TY ”"FAMOUNT_cPAID _� �,� x PAID DATE': wACCOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 • $0.00 PAID?BY'�` SfFMETHOD� ��sV•�x ;RECEIP,�T#`a�CHECK# CLfD BYf -`> • M Total Paid for REMODEL:, $223.34 R $0.00 ` DESCRIPTION y as - * ACCOUNTSPTY,� AMOUNTmv r;i 3 w::t•, s _g. K (PAID aFPAIDDATE SMI - RESIDENTIAL 101-0000-20308 ' 0 $1.30 $0.00 r PAID?BY r� aMETHOD E; RECEIPT # CHECK CLTD BY ; r r_ # Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.30 $0.00 TOTALS:• - lo 'App ied to'.� Type:-BUICDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED-CONDITICINS Applied: 4/6/2015 PJU Approved: 4/22/2015 LUR Parcel No: 770091010 Site Address: 78SSO AVENIDA TUJUNGA LA QUINTACA 92253 Subdivision: DESERT CLUB TR UNIT 5 Block: Lot: 17 issued: RON Valuation: $10,000.00 Occupancy Type: Consfruction'Type: Expired: No. Buildings: 0 No. -Stories: -0 No. Unites: 0 ails: CONVERT MASTER BATHROOM IN TO AN ADA MASTER BATHROOM. WORK TO INCLUDE PLUMBING, ELECTRICAL, MECHANICAL, AND SOME FRAMING. SEE ATTACHED COMMENT SHEET. 'App ied to'.� ., ——- ' ` . . � .' ' , � ^ ' � Printed: TuesdeKApril D�ZO159:3]�6AN1 �' ` 1ofJ . ' ` . . . W^='"= . SITES RON PLAN CHECK SUBMITTAL PHILIP JUAREZ 4/6/2015 4/6/2015 PLANS SUBMITTED BY JULI HAFDELL 60-771-4066 CONTACTED-JULI HAFDELL AND LEFTA MESSAGE, LETTING HER TELEPHONE CALL LUIS URIBE 4/22/201S 4/22/2015 KNOW THAT HER PERMIT WAS APPROVED AND READY TO BE ADIDRiiSSi TUJUNGA ., ——- ' ` . . � .' ' , � ^ ' � Printed: TuesdeKApril D�ZO159:3]�6AN1 �' ` 1ofJ . ' ` . . . W^='"= . CONTACTS . . ....... . . ......... ' ` NAME �ME A66 RES uSTATE� ZIP PHONE: ,EMAIL OWNER JULIHAFD . ELL 78550 AVENIDA LA QUINTA CA 92253 (760)771-4066 TUJUNGA' FINANCIAL INFORIVIATIOU..,. . .. .. ... W, �K. 'i"P. DESCRIFjTIONN%'4,,., ACCQUNT�� 1," AMOUNTZ PAID�D M' -RECEIPT I.PT#' By. BSAS SB1473 FEE 101-0000-20306 0. $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: DEVICES, FIRST 20 101-0000-42401 0 $24.17 $0.00, DEVICES, FIRST 20 PC 101-0000-42600 01 $74.17 $2 $0.00 Total, Paid for ELECTRICAL: $48.34 $0.00 FIXTURE/TRAP 101-0000-42401 0 $48.36 "$0.00 FIXTURE/TRAP PC 101-0060-42600 0 $48.36 '$0.00 WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALf/kEP WATER SYSTEM 101-0000-42600 07 $12.09 $0.00 1 1 1 INST/ALT/REP PC • Total Paid forPLUMBING FEES: $120.90 $0.00 REMODEL, EA 101-0000-42400. 0 $21.75 $0.00 ADDITIONAL 500 SF r. REMODEL, -EA 101-0000-42600 0 $17.40 $0.00 ADDITIONAL 500 SF PC REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $0.00 REMODEL, FIRST 500 SF 0 10.1-0000-4Z000 ,>134.05. ;lu.uu PC Total Paid for REMODEL: $223.34 $0.00, Printed: Tuesday, April 28, 2015 9:33:46 AM 2 of 3 Cfl?w.1YSTEMS t tGF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . .. . . . . . . . . . . . . . . . . PARENT PROJECTS ...... ........ ............ 777777 'F�ID'DATE "`CHECK#44 P DESCRIPTION -;4V, ACCOUNTi QTY", OUNT-lt�l ,PAID RECEIPT $V METHOD SMI - RESIDENTIAL 101-0000-20308 0 $1.30- $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.30 $0.00 . .. ........ . ... .. ....... .. .. .... . ... .... ..... ......... ... ..11-11 ..... ...... d . ....... . . . .... TOTALS: . $394.88 .$0.00.1. .. ..... ... ..... ........ ... .. .... .... .......... . ..... ... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . .. . . . . . . . . . . . . . . . . PARENT PROJECTS ...... ........ ............ t Din # .0ty of LA Q uin to . \\C\ Building $r Safety Division o P.O. Box 1504, 78-495 Calle Tampico. -- La Quinta,.'CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # \� Project Address: Ob �` Owner's Name: U' 1. A. P. Number: 'To Address: - .865• trd'•t-. 10 lokiqa Legal Description:htQ-City, ST, Zip: Ul%� C Contractor:In r^ 0 CA- 61a� Telephone: LQa —4wu Address: Project.Description: (0 C ei City, ST, Zip:. ' Telephone: OEM= r State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ;.<.:::>:>::;> s:::;>:°>- "'^: Construction Ty pe: Occupancy: State Lic. #: ' a circle one): New Addn. Alter Repair P ProJ ect type ' air Demo Name -of Contact Person: v I(` .- Sq. Ft.: #Stories: #Units: Telephone # of Contact Perso :-i (a.. Estimated Value of Project: 16,00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. , Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" 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 Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees R ^r Tdfs ; P.O. BOX ,1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO 760)7 1 77-71012 LA QUINTA, CALIFORNIA 92253 FAX •(760) 777=7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits I I IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building ermit has been s bWd m your name li g yo self s e 1 oL f_the property improvements specified at ��Q�,1 i. U� 0; ' We are providing you with an Owner. -Builder Acknowledgix nt Information Verification Form to make you aware. of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this, form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signer you understand or verify this information. Al. I understand a frequent .practice. of unlicensed persons .is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on. my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers, on my property. a Jo. I understand building permits are not required to be signed by property owners unless they are responsible for the ' ``construction and are not hiring a licensed Contractor to assume this responsibility. �J 3. I understand as an "Owner -Builder" I am the responsible. party of record on the permit. I .understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in'California and to list their license numbers on ermits and contracts. J 5. I understand. if'l employ or otherwise engage any persons, other than California licensed Contractors, and the total value ' of my construction is at least five hundred dollars ($500),_ including labor and materials, I may be considered an ".employer" Jmove r state and federal law. understand if I am considered an "- 6. I employer" under state and federal law, der register with'the state and federal . ment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial �. I understan � .. , d under California Contractors State _ 6 License Law, an Owner Builder who builds single -residential structures cannot legally build them with .the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 1) 8. I understand as an Owner -Builder if I sell ther p operty for which this permit is issued, I may be liable for any financial or personal injuries sustained by any subsequent owner(s) that result from .any latent construction defects in the 1orkmanship or materials. 9. I understand I may obtain more information regarding'my obligations as an."employer from. the Internal Revenue Service, the United States Small.Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed.contractors. 10. I am aware of and consent to an Owner -Builder building permit applied, for in my name, and understand that I am the party- legally and financially responsible. for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I willr abide by all alp laws and requirements that govern Owner -Builders. as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the -information I have provided on this form Licensed contractors are regulated bylaws designed to protect the public. If you contract ,with someone who does not have a license, the Contractors' State License Board may be.unable•to assist you with any financial loss you may sustain as a result of a complaint.: Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working, on your property, you may be held liable for damages..If you obtain a permit as Owner -Builder and. wish to hire Contractors, , you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the,permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the.property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF.AGENT TO ACTON PROPERTY OWNER'S BEHALF . Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize - the following person(s) to act as.my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the,propeity owner for the address listed above and I•personally filled out the above information and certify its accuracy. Note: A copy of the. owner'sdriver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: CITY. OF LA QU.INTA .SUB-CONTRACTOR LIST JOB ADDRESS "7$SSD Ave, TU. A PERMIT. NUMBEf C3 S�tS'61<�( OWNER1�i�JJ Y"jE1L1__iAFpG7,4.L BUILDER This form-shall be posted on the job with the Building Inspection -Card at all times in a .conspicuous place. Only persons appearing on this list or their'erriployees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will-result in a stoppage of work and/or the voidariee ,,• �. . of'building `permit. For each applicable trade,'all information requested belowmust be completed by applicant. "On File" is not an acceptable response.. _ c _..Classifi a �on...........................::....Co.ntcactoc.....:.................... .....:.:...................:.,........:.............. ............ .... _...........::.:;.........::::::::.::.::..::........ .:........................State:Contractor..s.Uc.ense................................:.................................W.orkecs.. Com .ensatwn.lnsu .a c.e............... ........................................ i � >Busm s.. f � Y ................:..,.. rce 'Company Name CIassifisation License Number EP. Date Name PoliNumber sY Exp. Date � License Number:Cori Date Exp.. i AB C 8 xxxxxx _ xx/xx! x.(e.g.,(eStateFund CalComp) (Format rie xx xx)(e.9 ( xxx x ) (xx xX x x )s) EARTHWORK (C 12} / r c _ CUNGRFTE {C 8)- _ c i .� ��97z 30 S - ai i 0 J- OOO(� l IJP I 1 < • .STRUC-( STEEL (C 51j - •, , �JIASQNRY (C?--29:); `.> '<:; w 2S2?4�6i- Mt 3t } PLUfJIEiING:IC 36?::::>:::>:>:>::>ubi 8- +`ATSTER>{Cs' ::,.51::<>'>::: i DRYWALL (C 9) 'F.VlkG< :C'2 �( :.ELECTRICAL ... 7ri pS- 3�ICIq QNG ) e SHEET:META.:.:.tg3:):::;::::::. t • F F ,� . c .t :;SEWAGE. DISP (C-42} • • � .. - � ' � '` _ 'ERAMIC TILE;:(C;.54_):;':< ; ' - _ 0 In August 2014, the day after his 50th birthday, Randy Hafdell suffered a ADA., massive hemorrhagic stroke. He spent the first month after his stroke gradually emerging from a coma in the Neuro ICU. He suffered several serious complications and was medically unstable during that time. A t� craniotomy was performed, removing a large portion of the skull to relieve Z swelling in the brain. He wore a helmet for 3 months until they could replace the skull flap. The doctors informed his family that his prognosis was very poor and they should be prepared to make some difficult decisions. Seven months and three hospitals later he continues to suffer from right-sided 3 paralysis, has no speech and limited comprehension and cognitive skills. He has recently demonstrated emerging voluntary movements in his right leg and1<5 slight improvements in comprehension. His therapists are hopeful that with ongoing intensive therapy he could one day walk with the use of an assistive device. Unfortunately, his speech has not returned. Randy's lack of ability to communicate creates extreme difficulty and frustration for him and his family. His language deficits are profound and will require lifelong treatment. Prior to this incident, Randy had no medical conditions and was extremely healthy. He was a sixth grade teacher who loved the outdoors and had a *< passion for fishing. He is a devoted family man with a loving wife and twin 9 ��Q. year olds. Randy will be unable to work . Juli indefinite) y , his wife, left her teaching job ,� this year to care for him and their children. She will need5 to resume work in September. POQ` Currently, Randy receives therapy at the Centre for Neuro Skills (CNS) in Bakersfield, CA. The facility is one of the few centers in the U.S. that oP� specializes in long term treatment for patients with brain injuries allowing him RECEIVED to benefit from their intense rehab schedule which cannot be matched locally. APR 0 6 2015 This will likely be a lifetime effort, but Randy has an amazing spirit, CnIfOFLAQUWA exceptional work ethic and a family that loves and su COMMUNVYDEVELOPMENT pports him very much. AVt-t4J9A its r% A �tNIPA n 'G4�iLo PIS Q t E L. tt 7700 11010 - _ -� 765;_50 AVG:- -rujur4cax APR 0 1�Z2117 A.Q111t%kTA) CA COMMUNITY DEVELOPMEh R) Nby JUU( MAF-D.C.LL ADA 6Ai'VA SCALE:APPROVED BY: AS 'S Nd.�x/N DRAWN BY Pn_tf,.. DATE: REVISED 76-S50 AVE. `t`WUN&A C -f\ DRAWING NUMBER I 5—A L xa5r10ct sr.T to r ADA FAQ E l- N 1 T -Y f CLR. .i CP�l3 C'i'h t L`- Xt5T.IN6 13NrH RC -MOVE* , l,4 14 -7Yk sk- Ott a 1 REMOVE VAN t" 9' q %Z 'l RE've-9ZE POORs �l N: �r 14' - 7AA J REMOVE , Tug �SAO.W . 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