9603-073 (RR)LICENSED CONTRACTOR DECLARATION
kilereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
j. MLicense # Lic. Class Exp. Date
r'Lu 7015612 L -3!a 1/3I/97
0 � 11 /Date Signature of Contracto -�-......,.-
�D °) OWNER -BUILDER DECLARATION
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ (n License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
O N
Q WORKER'S COMPENSATION DECLARATION
CL
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO - O () 1 have and will maintain a certificate of consent to self insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit.is issued.
CD Q U ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 31700 of the Labor Code, for the performance of trhe, I rkk for which this
d LO f— permit isrls�W, M� v�`arkers' compensation insurance carner & policy no. are:
1q41 ZZ1 Carrier Policy No.
J
cb
�a
J (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
1 subject to the workers' compensation provisions of Section 3700: of the Labor
•�•i7 Code, l shall, fo with comply wit �thoe pr" -ions:
Date. Is`2 Applicant- <--~~-- • .�' . •�
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. 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 1180 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
the above-mentioned property for inspection purposes:'
Signature (Owner/Aget, •�-� �. Date
!1�-fI7
BUILDING PERMIT PERMIT# CONTROL# 2971
DATE '111W% VALUATION ��� {(1,JI LOT TRACT
JOB SITE
ADDRESS 53460 A%iF.Nf0A i)RItc,iiON
APN 774-1155-008
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CF,NEf%�A MARKS
1111001;S ROOFING
_53660 AVE N1l3A 0BR EI.AO .
P.O. 60 3722
[.A Q1JTNTAj.,A 92?53
PALM DF.AXI' CA. 92260
((�1��15fi�1:iln3
ill)508-9212 CALK 1142
USE OF PERMIT
O NFRAL N+)ti.dAWT,
t'tN'sRc3C�1�
_.;.a . ru .t.4
FSTI.MRitiT.E D C"4:iST Uig CCDivtTI i7C."1']ON
3,164410
Rfs►'.f iFr 101.000-+1 i 94..10 $36.f10
SLS -"1"C f11L fit ►N� T'f,2rfC`I'COI+Y I�i.0 Ptah! C II CK
Q LESS 11111;-! AID FEES
$30.00
60.()0
fAI1 PERMIT FIMS 5)1' E fitW
PRAR'8 1996
$30,00
By
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
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
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 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
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.L.
Smoke Detectors
Temp. Use of Power
Final:
Utility Notice (Perm)
Pj
PRODUCT %t!V �' B Inc. Groton. Man. 01471. TO Order PHONE TOLL FREE 1,M225-6760
BROOKS ROOFING COMPANY
/ P.O. Box 3722
PALM DESERT, CAA
92261
Contr. Lic. #701562
(619) 568-9212
To: ..... ......C.i..t.y.... o f .....C.a.t.h.e.d r._a.l . C.i.t..y.
... .................. P.......0... ........ Box .......3..7.2.2 ........... ...... _ ........ _.............................................. .. .
........................ C.a: t.h.e.d r. a.l......_C. i.t.y..,......... C A ... ......... 9.2.2.5._3. ............................... ........ .... ..
We hereby submit specifications and estimates for:
...................................... 1..9.......s.g.u.ar..e_:..................................................................................................................
..
Fold at (>) to fit 5015_DU_0_VUE0 Envelope
PROPOSAL.
Page No. of Pages
H,It vAw:i vo.
ROBERT MARKS
Ll K.rCrION
�i
53-660 Ave. ObgWgon
La Quinta
PIiDNI: � 70"Ct.
564-3693 30,.1995
I�m.00
to sheathing.
WE PROPOSE hereby to furnish material and labor — complete in accordance with these specifications, for the sum of:
-----THREE THOUSAND ONE HUNDRED SIXTY AND N0/100--- dollars ($
Payable as follows:
In full upon completion
3,160.00_).
All material is guaranteed to be as specillecl. All work to is rolnplewd in a workmanlike mumu:" t
according to standard prarlices. Any; ller lion or, deviation from above spccifical ions involving Authorized, 1\ ; ..i \ 1w l.• w .
extra costs will be crecu0111),ted0111), upon u• written orders. and will becunan extra charge over Signature Norma Miller
•
and above the estirnate. All agreements contingent t.ipon strikes. accidents or delays beyond
our control. Owner to carry fire, tornado. and other neccssary,insurtmcc. Our workers are fully NOTE: This proposal may be withdrawn
covered by Workmen's Compensation Insurance by us if not accepted within days.
ACCEPTANCE OF PROPOSAL — The prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do
the work as specified. Payment will be made as outlined above.
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 -' (619) 777-7000
FAX (619) 777-7101
March 20, 1996
Brooks Roofing Company
P.O. Box 3722
Palm Desert, CA., 92261
RE: 53-660 Avenida Obregon
Dear Kim,
On my third visit to the job site I advised employee Bob Wire that the roof was not
ready, there was the need for replacement of a f.ew pieces of roof sheeting. and to
sweep roof clean, and to call you (Kim) when the job was ready.for a pre -roof sign
off. You phoned and advised me the job was ready and I stated that I would be
there before 3pm to re -inspect. On my. fourthvisit to accommodate the pre -roof
inspection, the roof was based and second ply started. Your office was contacted
2:30pm and advised to contact you and stop work.
Remove -roof -and expose roof sheeting for pre -roof inspection. A $30.00 re-
inspection fee is imposed. Pay re -inspection fee and provide receipt to the Building
Department prior to rescheduling pre -roof inspection.
If you should have any further questions please feel free to contact me at 7.77-
7027.
Sincerely,
Depart ent of Bui di g and Safety
Daniel P. Craw ord
Building Inspector I
cc Geneiva Marks
File
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
CONTR. LIC. #XO X #701562
BROOKS ROOFING.COMPANY
P. 0. BOX 3722 - PALM DESERT, CALIFORNIA 92261
March 22,1996
City of La Quinta
P.O. Box 1504
La Quinta, CA.
92253
Re: 53-660 Avenida Obregon
Dear Daniel:
Thank you for your cooperation in regards to pre -roof
inspections at 53-660 Avenida Obregon.
The upper roof was in a newer..condition with one roof
and an existing smooth surface which we roofed over.
The lower roof consisted of three roofs, which we tore
off down to the sheathing.
Sorry for the inconvenience.
Sincerely,
Norma Miller
Brooks Roofing Company.
10
(619) 568-912