Loading...
0210-178 (RR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under "provisions-oP* r�tiapter 9 (commencing with Section 7000) of Division*8,of;the Business and P*ibfessionals Code, and my License is in full force and effect.' T License # Lic. Class Exp. Date t` `r5i36394 C39 T;VC `�� 013'3I Z( % fir• 0.`1 4 t{s f ... Date rac Signature of Conttor�•�•-i . 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&P.C. for this reason Date Signature of Owner 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 & policy no. are: Carrier STATE FUND Policy No. 1613416-0.2 (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 mariner,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. DaPe',-%l t — Applicant- % /" – - I ,%...ee 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, 1. Each person upon whose behalf this application is made & each.person at whose request and for whose benefit work is performed under oorApursuant 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 f the above-mentioned property for inspection purposes. •`'` �✓:,....... 't``��.`� EJ � � � �� 1. Signature (Owner/Agent).? +.r ._ ©ate i L,n _,.BUILDING PERMIT.:. PERMITk 1 DATE VALUATION LOT TRACT JOB SITE _ _ _ �• ADDRESS aon•-a! 1w w. _..� aw V �� 9 �`O D131�Ld50�� APN ' OWNER CONTRACTOR / DESIGNER / EN (NEER LA QUbiTAREAL.. ,ice" aA1 , ROOF "MA -SM, �'fW.VY 78.023 C' ALLE ESTrADO 74•-9x30 RU:13AWAT BAY DR LA C�UMA CA 922.53 REEL :DA DUNES Circ P221 1 USE OF PERMIT GIN1ERAL BUMD]NO P. R00F'f:3Ha"MGL..iZSu'd.6.r'4,.:i"S A TMiA`t'1GRiALS t' NLY ''d'AIXA'TIM 4,lOS.00 LS MEM° U111(:08T OF cCbT@•,,MI UC"LTB3M 4,1ft t3 ' _►F°Sc`RLI/AT'L` PW, SUMMARY Y REROOF FRIe 101.000.418.000 $30.00 -3 !lA.�D�# '�"Yi�IJ-0 . ` ... . 1TCI1•CJR AM 1:'Xr01 CWj—'X $30.00 TiIM PRE.-PeP,IDIM , $0,00 TA L :1 `7 ZId I.':F•L+ f: FS MTM NOW CITY OF LA QUINTA FINANCEDEPT RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD - '► OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Jz 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 BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond 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 i Gas Test Appliances . v 1 Final Final ' tility 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) COMMENTS: - `- G - Y P.O. BOX 11257 PALM DESERT; CA 92255 PHONE 760-200-0811 FAX 760-200-0801 A proposal (submitted to: LA' QUINTA REAL ESTATE ATTN: KEN Mailing Address 78023 CALLS ESTAbO. LA QUINTA, CA, 92253 Job Address: e 51940 OBERGON. LA QVINTA,. CA 92253 Phone:160-564-4218 Description of Work46 Be Performed; OBTAIN ALL REQUIRED'CITY PERMITS. .REMOVE EXISTING TSAR AND. GRAVEIAOOF AND DISPOSE. NAILI'(ONE LAYER 15# FEET OVER -PREPARE!),, FACE. INSTALL NEW ROOF JACKS. `. INSTALL 30YEAR SHINGLES-TO,MANUFACTURES SPECIFICATIONS CLEAN JOB SITE TO.OWNERS 'STANDARDS. IF NOT ACCEPTED.IN 30 DAYS THIS PROPOSAL IS NULL AND VOID Notes: In Keeping with -Industry standards: 1. This guarantee does not coverany damage to the interior or exterior therein This guaran does not cover damage to roof due on whicli the:roof is applied or damage to.anytcontents gee to any cause beyond our, control, including; but not limited tq:. fire, lightning; windstorm, hailstorm, antennas or other equipment, foot traffk.on roof; structural fault or settlement, cracking or other failure of the roof deck, walls or foundation. of the.which the"*" is, applied:. 2. Should rt become necessary for the roofing .buil contractor to remove and/or'remstall,anyantennas, cooling or heating appliances or other equipment, whether or an charge is made for'such;work,- the customer understands that neither Roof Tile Specialty nor the not additional installevassunies anyresponsibility for the.peiforrna=•of said equipment. 3. Roof Tile Specialty does not assume any responsibility for corrections of existing code violations'or foi the repair of any existing defects unless Specified m.'estimate and proposal. :. . Total Cost: $4485.00 Terms paid on completion unless otherwise specified in the contract. If not acceptance in thirty days this,proposal is, invalid. Extra $35.06.'per�sheet of plywood,if needed. You'are hereby authorized,to.funiish all contents written in the contract to complete work mentioned }?f Acceptance:. in the proposal Contract for which Uwe agree to pay the amount mentioned, in said proposal, and according to terms thereof, (Initial)-' If a leakage, caused by defects in workmanship, occurs within TEN years from date of application we will repaii,it free of charge . . it understood that by theacceptaiice of this proposal you authorize Roof Tile Specialty to make the Installation: is r.:. installation;:to issue work.order with. specifications shown;herein'and to payour charge for such installation. You agree to pay the amount, the specified -herein, which wiWcover a price of said materials and labor charge. This estimate is based,on a complete job and aiiy.surplus material remains property of Roof Tile Specialty. Verbal understanding and agreements with representatives shal1not be_ binding`unless set forth herein. There shall be no liabilities for delays 'in, `or failure to.complete, :deliver or installation of all of any of the herein mentioned merchandise, if due to fire, strikes; war,' govermnerit regulations, or any cause beyond our contract. Any changes made by you in specifications herein, necessitating additional materials or labor shall not be included or covered by this proposal, but shall be provided for under separate,and additional order from you: (tial). Arbitration.of disputes: Any coiifroversy or claim arising out,of or relating`to this contract, or the breach thereof, shall be settied by arbitrator- in accordance with th applicable .Construction Industry Arbitrator Rules of the -..- American Arbitration Association -which are in effect at the time'tt demand for arbitration is filed. A judgement *, upon the award rendered by the arbitrators) may b&:entered in court having jurisdiction thereof. Any arbitration • award shall be subject to correction and/or vacation for _the reasons stated in the code of civil Procedure. The arbitration shall award reasonable attomeys .fees and expenses to'the prevailing party. After being given due notice; should.any party fail to appear ' or participate bithe arbitrator proceedings, the arbitrator shall make an award.based upon:the eviiience;prese1.nted by the party(ies) Who,do (does) appear and participate. Notwithstanding Contractor's'right to arbitrate contractor.does not waive any of -its hennghts. In the event of default by client in I -,. ♦ rn o-n.iohi;. �?tnrnai,c' faa'c an(t.rnct-incnrrerl in, .-.c_�. �_ ' ... s .>_.. ;.. �. '..�.. ..a ., .y . ...