BLDG (0110-023)52150 Avenida Madero
0110-023
LICENSED CONTRACTOR DECLARATION ".
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Divisio-..3 of.t .-o.Business and
i Ac
Professionals Code, and my License is in full force and effect.*
License # Lic. Class ♦ Exp. Date
691270, . C-3.9 , y J> A;30pw
Date Signature of Contractor
UILDER DECLARATION
1 -hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(mat 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 $If IF1h11„ Policy No. aQ9!`34.4+i
(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
subject to the workers' compensation pr#o lslons of Section 3700 of the Labor
Code, I shall foGthwith comply, t,Om ; rovisions.
Date:/—i 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, repfesentatives of this City to enter upon
the above-mentioned property o i(s ction purposes.
r^
Signaiure (Ow Agent) DateR ' {'
PERMIT #
BUILDING PERMIT:
DATE yy ,((' R. Dyppry VALUATION Sqyys .,@@ RRoo 11, LOT TRACT
,9,g.jf y Yb1Ybr
JOB SITE y y
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
dIMIAAWI1w1ir 111NEW
DWI
52150 AVEMIDAMADER0
31435 VIA LA,1'XU3 .Q
T -A QUWTA, CA 19221,53
IHOt.J:SMID ,PA., CA 9227£:6
(aMq)343-555 C91,6 3583
USE OF PERMIT
CM, MRAL IiMV114
Uig.Oi'ifa•',°&HpiJt.&I.J SICLASS A ;M,ATER.ALA; ONLY
R.h.f2. OOF I,1 I1.
: '`'.C.jlM TED COST OF COMM ON
3,104M
PERAW FEW SUMMARY
s C3fa r' 101-000-419.000
D -A D
OCT 0 3 2001
CITY OF LA QUINTA
FINANCE DEPT.
"
wUR-TL'9`F:14L C` OMR. -10011 1H AND JPLWCW
$30.00
" MAY, PERM H M,5 :L'► VY.K .i` 0W
MOP
RECEIPT
DATE
/ f?i 5/
BY
D F ALE
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
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation t
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
_
Final l d %/1 —Q
BLOCKVNAiLAPPROVALS
Final
POOLS- spas -
Steel
Set Backs
Electric Bond
Footings
r
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 ' 7
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances ' +
Final
b 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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
BUNDE ROOFING
& ASSOCIATES, -INC.
P.O. Bog 205 0 Thousand Palms CA • 92276
(760) 343-7555 • FAX (760) 343-7554
Stanley Sniff
P.O. Box 1414
La Quinnta, CA 92253
Re: Estimate re -roof shingles
52-150 Ave. Madero
La Quinta, CA 92253
FOR THE" OF: $3,104.00
We uropose to furnish and anniv the followiiifflabor and material:
Tear off existing gravel roof and haul away. Inspect sheathing for dry rot, and replace any damaged
wood on a time and material basis at a rate of $40.00 per sheet replaced upon approval of owner or his
elf -
agent. Re -roof with one layer #15 pound felt nailed to hold in place. Over felt install news year gee.
sealing dimensional shingles to manufactures specifications. Install'individual
dual units
nd to be, on
Clem
and
away
Clean and paint all roof flashings with rust proof paint, replacing any
all debris caused from above work and leave area clean. This estimate includes no extra. If you have
`
any questions regarding this bid please feel free to call. Afive-year guarantee will be in effect upon
payment in full.
TERMS: 100% UPON COMPLETION, UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE:
THIS ESTIMATE IS GOOD FOR 15 DAYS FROM DATE BELOW.
IT IS HEREBY AGREED BY BUNDE ROOFING & ASSOCIATES, INC- AND THE OWNER THAT WE
THE CONTRACTOR SHALL NOT BE LIABLE FOR ANY OF THE FOLLOWING: DIRT, ROCK; OR ANY '
DEBRIS THAT MAY FALL BETWEEN THE SHEATHING BOARDS ONTO LIVING AREAS.
DAMAGES TO ANY CEILING Mow= FIXTURES, VENTS AND OR CONDUIT PIPES,
STRUCTURAL DEFECTS IN BUILDING. IT WILL BE OWNER'S RESPONSIBILITY TO REMOVE AND
RELACE ANY ROOF MOUNTED ANTENNAS AND/OR SOLAR PANELS.
IF THE SERVICES OF AN ATTORNEY MUST BE EMPLOYED TO ENFORCE COLLECTION, THE
OWNER AGREES TO PAY ANY ATTORNEY AND/OR COURT COSTS,
CONTRACTOR'S ARE REQUIRED BY TO BE LICENSED AND REGULATED BY THE,
CONTRACTR'S STATE LICENSE BOARD.
1020 N STREET
SACRAMENTO, CA 95814 LICENSE # 691270
Respectfully submitted by( Q' , Date: September 7, 2001
Accepted by:
Date: Q t 1` iCf d l