BLDG (0208-322)51600 Avenida Martinez
0208-322
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under *visions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business apd
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
741152 039 ?0131/01
.Date 2115 ignature of Contrac
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
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. M-02 001294
(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
Code„I shall forthwith comply with those provisions.
Date N • _yrx ' f,"r, 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
the above-mentioned property,for,.inspection, purposes.
Signature (Owner/Agent) '""”" Date' !T'
BUILDING PERMIT PERMIT #0"-1.22
DATE sn s t VALUATION s6, Oft LOT TRACT
JOB SITE
ADDRESS M -6W t"ITlRNMI ,P l IAA)ZJ'TKZ
APN - -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JIM CA7111C.I+ Wr
PRO -IfFUH R0014ING Co.
51.001.MUM TGAN'ERi7.i't.1 ..'+
78-670IISGINVA.X 111 STT 185
LA QI.1FN`rA CA 92253
LA Qj.JI rik CA 92253
(d6t)pr,0-8099 (MIX 1923
USE OF PERMIT
Gam ,.t3T..tU.IING
If.L,R00H WITH MACSLE 1.1rg ROOF 'I'1f,M * ICH 21f 460
VALUATION 618MOD 1A
1I.WiiMA'IRO CIDS'I' Or, t';Q.NF:IT(IJUIT N
6AW.oyl?
PE's°M1'I'.i+" ' E."i7MsfR.'Y
R1? ROOF FEE 101...OW-418.000 $30.09
.a:
M3_1 t tfiAi. C i" 1 ITC.11101i A'tstT) P AW CHECK
$3011)
t 1M. 09 TIRE-1"aGM)MM-11
$0,00
/,rjr, 2
AL PFIRJlM'.) U.S DAM NOW
CITY QF LA QUIN7A
FINANCE DEPT.
MOO
RECEIPT
DATEBY
DAT FIN LED
Z_
INSPE T
iG
o 0
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�o
p
Final
Final _ - d _ G
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
F, tings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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:
F
RR,O-TECH ROOFING, INC.
78-670 HIGHWAY 111 SUITE 185
LA QUINTA, CA 92253
(760)360-8099
LIC.# 741152
NAME/ADDRESS
LAQUINTA PALMS REALTY
51-001 EISENHOWER DR
LAQUINTA CA 92253
564.4104
ATT. JIM CATHCART
DESCRIPTION
REROOF W/ LT WT TILE
PROPOSAL
DATE PROPOSAL#
10/8/2001 987
JOB ADDRESS
51-600 MARTENIEZ LAQUINTA.
1. REMOVE EXCISTING ROOF TO SHEETING, REPLACE ALL NECESSARY PLYWOOD @
$30.00 PER SHEET.
2. INSTALL ONE PLE BASE AND 2PLY MODIEFIED RUBBER TO FLAT ROOF AREAS.
3. INSTALL ONE PLY 40 LBS TO TILE AREAS AND ALL NEEDED SHEET METAL.
4. STACK TILE AND TRIM ON ROOF AND INSTALL AS PES ICBO SPEC.
5. CLEAN UP JOB AND PAINT VENTS TO MATCH TILE COLOR.
Thank you for your business.
David Krastel, President.
TOTAL
THE ABOVE 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.
SIGNATURE
4
TOTAL
6,800.00
$6,800.00
41 X660