BLDG (9612-059)53815 Avenida Madero
9612-059
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed trlder 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.
License # Lic. Class Exp. Date
3365.j7 C's3 71+iiti
<< -Signature of Contractor • 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
Se ion 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 Policy No.
CALCON(II W9551183f 3
(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 provisions of Section 3700 of the Labor
Eode, I shall forthwith comply with those provisions.
Date: • 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
/thabove-mentioned property for inspection purposes.
ature (Owner/Agent) - Date
BUILDING PERMIT PERM'
CONTROL#
[N
"12- 9
4454
DATE 51) VALUATION , ►a,+; {i LOT TRACT
JOB SITE
ADDRESS . •S : A i ltti l► [Vi. iii ,ltCe
APN
774442-617
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ItI:"I{ARI? A: LANf X 11`11 SI1 C
AL MII,[..I:It 1,' SONS ROOFING
53815 AV, E IDA n.3iil E .i
687W :+iiMAu"f' MlJE
LA (.,11. Pr1'A CA 92253
C'.A•1.I-1EDR.A1, CrIT
CA '12234
(6101328.6616
(",I L-9
106
USE OF PERMIT
GENVRA1, BUILL)ING,
RI's140W11' f AlST)NO R<:)O IINv AN -0 Ttli-.RCWJF WITH 25 YEAR 8[IfNIGLES
i iVER 30H trlsiX. 'nwim vli.y It rr w x)1% A'1' 17.A1' ARRAS.
RE.Rt 0 F 3,,W0 ,00 LS
1:.51TINA iATE1) COM' OF CONS'1-i IX 1' 0IN
3,00.00
PERMIT FEW, -SUMMARY
RJ.K()F FEE 101 -OW -1118.000 S r.rtr►
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Cn
ILLU
• W
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sC1I3=1'C1 W MNS'[Rt IC`11041 AND PLAN ("14FCK
, i(1.(N}
LE PRE -PAID FEES
r" .
$009
'1`C1`i'A). PERMIT Mli_'S i VE' NC)W
$30.00
l
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dryw@II - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
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:
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)
ME
r,
c .:'h:1wt:"r' 'ni'•* 'f'r w-��r •�,�Y�' t�.iH.Fr`i' F.
"BETTER ROOF SFOR.dE7TEA'LIVIfyG�
68760 SUMMIT DRIVE,. CATHEDRAL' CITY, CA92234.- r
(6i9j 346.1214 and-32Ma6"
STATE LICENSE -336547
PROPOSAL -AND FREE ESTIMATE
Location of Job La Quints, . CA
`Lani Whiteside CONTRACTOR OWNER
53-815 Madero
La Quints, CA 92253 346-3861
We propose to furnish the_following materials and perform all labor necessary to complete the roof at the above location.
Roofer to remove existing roof down to sheeting. Any damn ed- i od needinit to be t,
replaced will be at the rate of $35.00 per 4x8 sheet.
Roofer to then nai.one (1) laver 30# felt to deck inw Ari �S
,K , Vwar Afn�ne�w 1
,rshingles per manufactures specifications. Roofer to hot mop entry way and install
new unpainted edge metal.
r
CONTRACT PRICE: ;3,600.00
All of the above work to be completed in a substantial and workmanlike manner according to standard practices for the
SUM of $ Three thousand si: h,t.,�red Dollars ($ 3.600.00 t
TERMS: Net Cash on Completion. ;
ATTENTION `
Section 7018 of the Contractors License Law (B & P Code, Div. 3, Chapter 9) provides that starting July 1, 1966, everyone licensed by the Contractor's
License Board shall give a copy of the following notice to the payor prior to receiving •from the owner of the property or his agent any payment for work
which a contractor's license is required.
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1181 et seq.), any contractor, subcontractor, laborer, supplier or other person
who helps to improve your property but is not paid for his work or supplies, has a right to enforce a claim against your property. This means that, after a
court hearing, your property could be sold by a court officer for the proceeds of the sale used to satisfy the indebtedness. This can happen even If you have !'
paid your own contractor in full, if the subcontractor, laborer, or supplier remains unpaid."
Al Miller & Sons Roofing. Co., Inc. agrees to furnish its regular form of Guarantee for 3 years after Of its work, sd
to i;over
defects in material and Workmanship only and not to extend to damage to roofing caused by the elements, otheretion u usual causes or Ac suarantee of God and shall
not cover any liability for-dbmage to interior fixtures, decorations, walls, contents of building or other parts of structure not to damages arising from faulty
construction. It is also understood and agreed that the above guarantee shall be made and remain only when and If payment Is made as agreed in this
contract. Al Miller & Sons Roofing Co., Inc. is not responsible for TV antennas.
We are fully covered by workmen's compensation and public liability insurance. Carriers' names and policy numbers available on request.
Any alteration or deviation from the above specifications involving extra cost of material or labor will only -be executed upon written orders for same, and
will become an extra charge over sum mentioned in this proposal. All agreements must be made in writing. This offer is valid for one week from the date of
estimate and is based on free access to building for direct loading from our truck.
Prices are based on current cost of material and labor. Increases or decreases will be reflected at time of signing of contract.
Not responsible for any damage to sidewalks, curbs or driveways.
Respectfully submitted,
ESTIMATES AL MILLER & SONS ROOFING CO., INC.
Accepted:, /i 1 %u !� By: 4 ^-
Mott `
Date
_,19W Daft December `$ . 19,4�b
s: