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0110-097 (BLDG) LICENSED CONTRACTOR DECLARATION PERMIT# U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT I— ter 9 Cha (commencingwith Section 7000 of Division 3 of the Business and 01.1 .4"7 04 Chapter ) :DATE VALUATION LOT TRACT WProfessionals Code,and my License,is=in"fullforce and effect. dBt License# Lic.,Class Exp.Date CYtoJOB SITE V y APN w _ L"sS7Cat13'kd ; ADDRESSk� �g. g , "P[.dT�� :"-F•� f J ! ? Y OWNER CONTRACTOR/DESIGNER/EN (NEER 6 Z r— Dat e< t Signature of CbrItractor CID � E- CD�� '�•��-OWNER-BUILDER DECLARATION .,, ��•��'t.��•,!r►•��?:E��IHH�.TfTROOF TUX,MirOAVIT W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's "64'WCON 1N 74'°9"��UNIVRAY BAY DR. ~ U) License Law for the following reason: 1. d:WIN M CA 97,25.1 13EM iIDAUU.c !S CA 9.2211 Z_ ( ) I, as owner of the property, or my employees with wages as their sole (76q)200-•0511 MEW, 1420 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting,with licensed contractors to construct.the project (Sec. 7044, Business & Professionals `" �` r�Tf15�L+} M Code). t1�ii:)k?IREPLACE['ag.,t�VC SSS.A..f1l1.d�'Pi�RIA13 ONIX LO () I am exempt under Section B&P.C.for this reason N Date Signature of Owner ON 0) Z WORKER'S COMPENSATION DECLARATION , o I hereby affirm under penalty of perjury one of the following declarations: r Lo H O O 1 have and will maintain a certificate of consent to self-insure for workers' '& 413Oh X W !:� compensation, as provided for by Section 3700 of the Labor Code, for the mQ performance of the work for which this permit is issued. Q C) (' )_I have and will maintain workers'compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this d rn F- permit is issued. My workers' ccmpensation insurance carrier & policy no. are: It z Carriera1' f+e7 1g3 Policy No. 1�'1 Ads-t11 �,u"1Q�,�k.'�.RD+C:osT�?�v�£�C13Vs.£�k1�t�o.tq 50 a0 5 J (This section need not be completed if the permit valuation is for$100.00 or less). n.SIR 0Ole 1+1m1. 103.CI.DO.,418.001 MOD ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person.in-anv manner so as to become subject to the F^ workers' compensation laws of California and agree that if I should become subject to the workers'compensation provisions pf Section 3700 of the Labor 3 ; Code, I shalt forthwith comply,with those provisior)s. Date: 1( J k'th ,.Applicant\ '�� ...�_. �"°'-^ '"'.� `�`,,, • D Warning: Failure to secure Workers'Compensation coverage is unlawful and �C I I 0 QU 2001 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. CITY OF LA QtUINTA IMPORTANT Application is hereby made to the Director of Building and Safety FItdANCE?'D�PT. 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 i-8-'.b:�(�IAL�..C)i 5,4 UCTI fW AWL)PLAN CCK $3i_0 any permit issued as a result of this applicaton agrees to, &shall, indemnity L ES M-FAID IMS $0,00 & hold.harmless the City of La Quinta, its officers, agents and employees. 21 Any permit issued as a result of this application becomes null and void if 'ITj)VA L,P'pi 1YSIX ',�+,;S•U'U AOW S30M { 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 I IIIIIII VIII III VIII IIII correct. I agree to comply with all City, and State laws relating to the building 20 construction, and-hereby authorize representatives of this City to enter upon IE the above-mentione4roperty lqri Inspection purposes. Q [RECEIPT DATE J p BY Dr FN E O INSPECTOR _-,,,.Signature'(O'4wner/Agent) f Date ��,1 dP^' � ! -� 6 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 Wail Insulation Condensate Lines Party Wali Firewall t Exterior Lath i Drywall-Int.Lath n 9Z / _f, Final Final `V `Z�r �Y POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main'Drain Bond Beam Approval to Cover Equipment Location I Underground Electric Underground Plbg.Test Final Gas Piping PLUMBING APPROVALS Gas Test '' Electric Final Waste Lines Heater Final Water Nng Plumbing Final Plumbing iTop 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.PoC,ter Pole Underground Conduit i Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp.Use of Power R Final Utility Notice(Perm) ! Hoof Tile Specialty CONTRACTORS STATE LICENSE#636394 P.O.BOX 11257 Palm Desert CA 92255 760-200-0811 A proposal submitted to: MR. DONAHUE Mailing Address: 864 RINCON LN. PALACE VERDES ESTATES, CA 90274 Job Address: 49480 AVILLA LA QUINTA, CA 92253 Phone: 310-378-6203 WK 310-375-6536 HM FAX 310-378-4663 Description of Work to Be Performed: TILE AREA- REMOVE EXISTING ROOF TILE ANb DISPOSE.CLEAN ROOF SURFACE INSTALL 3"ICSO INSULATION V (OPTION-1/2 PLYWOOD COVER ADD$3480.00)NAIL TWO LAYERS 40#TILE LINER.INSTALL NEW ROOF FLASHINGS(H.V.A.C.&PLUMBING).LOW SLOPE AREA THERE WILL BE PROVIDED MODIFIED TORCH,UNDERLAY- MENT WITH TYWIRE.INSTALL NEW CLAY LIGHT ROOF TILE TO MANUFACTURES SPECIFICATIONS. FLAT AREA- REMOVE EXISTING BUILT UP TAR AND GRAVEL ROOF AND DISPOSE.NAIL ONE LAYER GLASS BASE. INSTALL NEW ROOF FLASHING AND PERIMETER METAL.HOT MOP THREE LAYERS GLASS PLY.FLOOD COAT ROOF WITH HOT ASPHALT AND COVER WITH ROCK. I IF NOT ACCEPTED IN 30 DAYS THIS PROPOSAL IS NULL AND VOID I Notes: In Keeping with Industry standards: 1. This guarantee does not cover any damage to the interior or exte- rior on which the roof is applied or damage to any contents therein. This guarantee does not cover damage to roof due to any cause beyond.our control,including,but not limited to: fire, lightning,windstorm,hailstorm,an- tennas or other equipment,foot traffic on roof,structural fault or settlement,cracking or other failure of the roof deck,walls or foundation of the building on which the roof is applied. 2. Should it become necessary for the roof- 1 ing contractor to remove and/or reinstall any antennas,cooling or heating appliances or other equipment,whether I or not an additional charge is made for such work,the customer understands that neither Roof Tile Specialty nor the installer assumes any responsibility for the performance of said equipment. 3.Roof Tile Specialty does not assume any responsibility for corrections of existing code violations or for the repair of any existing defects un- less specified in estimate and proposal. Total Cost:$ 18,250.00 Terms paid on completion unless otherwise specified in the contract. If not acceptance in thirty days this proposal is invalid. Extra$35.00 per 4teet ofplywood if needed. Acceptance:You are hereby authorized to furnish all contents written in the contract to complete work mentioned 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 repair it free of charge. Installation: it is understood that by the acceptance of this proposal you authorize Roof Tile Specialty to make the installation;to issue work order with specifications shown herein and to pay our charge for such installation. You agree to pay the amount the specified herein, which will cover the price of said materials and labor charge. This estimate is based on a complete job and any surplus material remains property of Roof Tile Specialty. Verbal understanding and agreements with representatives shall not be binding unless set forth herein. There shall be no liabilities for delays in,or failure to complete,deliver or installation of all or any of the herein mentioned mer- chandise,if due to fire,strikes,war,government 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. (Initial). Arbitration of disputes: Any controversy or claim arising out of or relating to this contract,or the breach thereof, shall be settled by arbitrator in accordance with the applicable Construction Industry Arbitrator Rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. A judgement upon the award rendered by the arbitrator(s)may be 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 ar- bitration shall award reasonable attorneys fees and expenses to the prevailing party. After being given due notice, should any party fail to appear at or participate in the arbitrator proceedings,the arbitrator shall make an award based upon the evidence presented by the party(ies)who do(does)appear and participate. Notwithstanding Con-