0402-070 (RR)54225 Avenida Alvarado
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LICENSED CONTRACTOR 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
Professionals Code, and my License is in full force and effect. '1
License # Lic. Class Exp. Date
6 12 0 C•39 ':SC11'
/Date Signature of Contractor
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
•1 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. 2851704.t13
(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 riot 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, ksliall forthwith comply with those provisions.
/Date: J / fes/ ht.( Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, -and hereby authorize representatives of this City to enter upon
theabove-mentionedprope for inspection purposses.
SY ignature (Owner/Agent) I ' - Date
BUILDING PERMIT PERMIT#
' -2-070
DATELOT TRACT
02/06/20C VALUATION
t2.945,00
JOB SITE ADDRESSS4-208!,t' ,.NID ALVARF1DO
APN _ ..
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DESERT FIRST REALTY
BUNG;• ROOFING & ASSOCIATES, "INC.
78.43$ HWY 111
31435 LA.PALMAS.
LA.QUDTTA CA 92253
THOUSAND PALMCA 92276
•
(760)343-7555 CI3141 3583
USE OF PERMIT •
GENERAL A ..MILUDNG
RE.ROOIPWITH SIUNOLE S.CLASS'V MATER
AL: ONLY. 7.001 CCC.
VALUATION MION Z9.43.00 LS
.S [IMAT. D COST OF C01r S RITCTION
2:,945.0€
PERMIT ' 1t'1±I:Ii SW/MAW
REROOF h'1`:.E
101-(100-4.18.000 $30.00
—C3 & [I
-;\
FEB 06 2004
2)
CITY OF LA QUINTA
FINANCE DEPT.
SUB -TOTAL CONSTRUCTION
` CTION AND PLAN CHECK
$30.00
LEES PRE.PA1D 1.40.
$0,00
TOTAL .PER IT 1♦. S DM NOW
S30.I.0
11110111111111 1111101 44
IE
RECEIPT
DATE //
BY,f-'i
D E FIN LED
IN PEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms a Footings
Ducts
Slab Grade.
Retum 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
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:
flee, ,i0d /-' a'-` g'" e cvl fAe
I
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
f
Temp. Power Pole
Undr,rground 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)
Doc 06 03 07:51a Bunde Rcofin8
p.1
BUNDE ROOFING & ASSOCIATES, INC.
31435 Via Las Pabras • Thousand Pam, • CA • 92276
(760) 343-7565 • FAX (760) 343-7354
DESERT 1IRST REALTY
78-435 HIGHWAY 11 I
LAQI!INTA, CA 92253
Rc: Estimate re-roorshingks
(approximately 1300 sq. R. of roof area)
54-208 Avenue Alvardo
IaQuinta. CA 92253
FOR THE SUM OF: 52.945.00
WR oronaa. to furni.h and 9 pIy the following IAhgr,gpd material:
Tear a fT existing roof and haul away. Inspect fur
a � and material basis at a rate of $40.00 ��� � rot and �� �y wood on
his along. anmaterial
with one ee 0I S per sheet (4 X 8 X '/:) replaced upon approval of owner nr
self-sealing�` pound la nailed to hold in place. Ova felt install new 30 year
dimensional shingles to ntanufacturac specifications. Install individual units nn all hips and
ridges to compliment new root Clean and paint all roof 8a with fad
found to be del'txxive. Haul away all debris caused from � work and proof
ata clean This
csthnate includes no exam. If you have any questions regarding this bid please feel free to call. A five-
year guarantee will be in effect upon payment in full.
This estimate does not include any architectural fuels It required by planning oommhtee.
TCRMS: tOM UPON COMPLNTION, UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE.
THIS ESTIMATE IS GOOD FOR 13 DAYS FROM DATE BELOW. THIS BID IS BASED ON CITY
APPROVAL_
IT IS HERP.RY AGREED BY BUNDE ROOFING & ASSOCIATES. INC. AND THE OWNER THAT WE
THE CONTRACTOR SHALL NOT BE LIABLE FOR ANY OF THE FO1_I.OWING: DIRT. ROCK OR ANY
to w lS THAT MAY FALL_ BETWEEN THE SHEATHING BOARDS ONTO) LIVING AREAS.
DAMAGF. TO ANY CEILING MOUNTED FIXTURES, VENTS AND OR CONDUIT PIPES,
SL'RUCTIIRAL DEFECTS IN BUILDING. tT WILL BE OWNER'S RESPONSIBILITY TO REMOVE AND
REPLACE ANY ROOF MOUNTED ANTENNAS AND/OR SOLAR PANELS.
W THE SERVICES OF AN A'T'TORNEY MUST KF EMPLOYED TO ENFORCI; COLLECIION, THE
OWNI; ( AGREES TO PAY ANY ATTORNEY AND/OR COURT COSTS.
CONTRACTOR'S ARE REQUIRED BY LAW TO BE LICENSED AN() REGULATED BY 1 IIE
CONTRACTOR'S STATF. LICENSE BOARD.
1020 N STREET
SACRAMENTO, CA 95814
MriCTTD
Respectfully submitted by
LICENSE ti 691270
47.1 a.. _cl t a •> eet. Date: Dec. ember 6. 2003
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