BLDG (0305-123)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.
License # Lic. Class Exp. Date
235717 C-39 B MC 01/31/2(
Date �- 1? % Signature of Contractor:;�- ,/" < !l
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.
t(/) 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 9TA1,p, "D Policy No.
045762442
(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 prpyisions.
D te'l
Applicant -
Warning:
��.-✓ �
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) /� i/�%• Date
BUILWING PERMIT PERMIT#
123
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 524,60 AVEN IDA ]' ENDOM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ter: E .'fVY1+YCrS7'Q J..
WESITM, PAC -00,R WPM
524160 AMMA NE.'?.a]DCIZ A,
3462 LA CAWAN WAY
LAQUIN.fA CA. 0253
PALM 9P1 NGS CA 52262
.(76"16.5877. C T.4 4293
USE OF PERMIT
MaRAL 13=JNG
l li;•,ROOIP"RIT)i :IQ Yl.d' R T)Ibti!\IPPI ?NAI, 31Ithl(.Lll Sy,.gTFIA CLASS,
°fie."MATFR.?A1.1 ;
VALUMIOpT
EMMAIM) COFf OF ivOMMUCT.LOd`N
+J0.�A s'�✓4�
PERAW. If`Tt > 8 vi'ARY
itEROOF FEX 101-000-418-000 X30. tlti
SAY 1 2 2003
CITY OF LA QUINTA
FINANCE DEPT.
RM -TOTAL CfJMMUMON AM Pi.AW CMCK
V0.00
12?.`43 Pl&.,-: AW FEE'S
MOO
TOTAL PFRMIF kMES DUE NOW
$30.00
RECEIPT
DATE,
By
DATE_ FINALED
IN SPECTOR
'_ , �� .-
v 1
.
INSPECTION RECORD
OPERATION T
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 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
rJ, 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:
t
r
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)
Sgnt BY: WESTERN PACIFIC ROOFING CORP.; 760 320 8912; Mar -18 03 13:45; Page 2/4
IL 74
Since 1949
March 18, 2003
Mike Livingston
52-160 Ave. Mendoza
La Qointa, CA 92253
WESTERN PACIFIC
Roofing Corporation
Lic. #235717
RE: Re-ruuring Project; 52-160 Ave. Mendoza, La Quinta, CA 92253
Application of 30 -year dimensional shingle roofing system.
Lear Mike:
Thank you tier the opportunity to inspect the moling system on the above referenced property. I laving -clone so we
are pleased to submit otir recommendations and proposal for the installation of a 30 -year dimensional shingle
roolinb system. The recommended scope of work and associated costs is as follows:
GENERAL
Unless expressly stated to the contrary, the contractor shall be responsible for performing the following acts.
DESCRIV110N
A. The .-enet-al conditions of this standard construction contract shall form a part of these specifications
with the same force and effort as though repeated herein.
B. The contractor shall furnish all labor, materials, equipment, permits, contractor's licenses and insurance
certifications to perform all operations required and specified. The contractor shall provide labor and
material cuslumarily included in work of the same nature to give a quality, conapiate Job.
C. I I' unexpected conditions are encountered during the work, and the conditions adversely attest the cost or
progress of the work, the contractor will notify the owner immediately, and the owner will negotiate a
change -order to resolve the unexpected condition.
D. The Contractor shall occupy, use, and permit others to use the premises only for the purpose of completing
the work to be performed under this contract with the Owner. The Contractor shall nut authurize or permit
arty other person to use said premises for any purpose whatsoever. Western Pacific is to be given all
reasunable srt-up and staging area.
E. Contractor's scope of work shall not include the identification, detection, abatement, encapsulation or
removal of asbestos orsimilar hazardous substances including mold and or mildew. If Contractor
encounters any such products or materials in the course of performing its work, or if such hazardous
materials are encountered by any other firm performing work at the johsite and contractor determines that
such materials present a hazard to its employees, contractor shall have the right to discontinue its work and
remove its employees from the johsite until such products or materials; and any hardrds connected
therewith, arc located and abated, encapsulated or removed, or it is determined that no hazard exists ( as the
sate may require), and contractor shall rcccive an extension of time to complete its work hereunder and
compensation for delays encountered as a rrsull of such situation and correction. With the possible
existence of mold from pre-existing conditions. Western Pacific nwling Corp. will nut be held responsible
fur mold related clairns resulting from mold detected at any time in the future.
3462 La Campana Way - Palm Springs, CA 92262 - (760) 416-5877 - Fax (760) 320-8912
www.westpacroof.com - E-mail: vvprcps@)vvestpacroof.com
Mike Livingston
March 13, 2003
Page 2
INSTALLATION OF A 30 -YEAR DIMENSIONAL ROOFING SYSTEM
PREPARATION
A. Tear off existing roof system down to the substrate.
B. Inspect plywood sheathing for damage. Replace damage sheathing at a rate of S45.00 per sheet or
portion thereof.
C. Dispose of solar panels on the roof surface.
APPLICATION OF DIMENSIONAL SHINGLES
A. Install one .layer of X30 underlayment mechanically fastened.
B. Install new 2X2 eve metal around the perimeter of the building. (unpainted)
C. Install 30-vear dimensional shingles to Manufacturers' specification. (Color to be selected by I-lomeowner)
i'
D. Install Crown Ridge at the top of the roof.
CONTRACT AMOUNT: $5,301.00
VOTE: The HVAC unit must be disconnected and re -installed durins the re -rooting process. This work IS included
in the contract amount.
WARRANTY
A five (5) year labor and materials warranty will be issued upon completion of the roof and final payment is
received.
PAYMENT TERMS
10 '%, deposit upon signing of the contract and the balance due upon completion. Invoice to he paid within ten
(10) days of receipt.
The price quoted has been structured to reflect standards we assume are mutually desired: quality installation.
service reliability and Ions -term performance. The price may be subject to change 15 days from the dale of this
proposal.
If you are in accordance with the conditions herein, please execute the agreement below and return both copies to
this office. We will, in turn, sign them and return one copy to you. Thank you for your cooperation in expediting
this contract for your roofing needs.
`i
Sent By: WESTERN PACIFIC ROOFING CORP.; 760 320 8912; Mar -18-03 13:46; Page 4/4
Mike Livingstuu
March IR, 2003
Page 3
NOTICE. TO OWNER
Contractors are rcyuirLd by law to be licensed and regulated by the Contractor's State License Boar -d. Any
quesbotos concerning a contract may be referred to the Registrar, Contractor's State licence Board, P.O. Box 26000,
SacrHtnento. California 95826.
ACKNOWLEDGMENT: Owner acknuwk:dges that he Itas read and received a legible copy of this agreement
including all tants and standard provisions before any work is performed and that tie has read and received a legible
copy of ivory other ducumtnt that owner has signed during this negotiatiun. I/we hereby acknowledge under the
penalty of perjury that I/wc am/are the legal owners and arr are authorized to sign this contract as ail ugcnt of the
legal uwner.
ACCEPTANCE: The above prices, specifications and conditions are satisfactury and art hereby
If secepted. You are authorized to do the work as specified. Payment will be as outlined above. Yuu. the
buyer mAy cancel th;k transaction at any time prior to midnight of the third business day after the date of this
transaction. Ser tie attached Notice of Cancellation furan explanation of this right. Owner hits the right to
require contractor to have a performance and paytnCnt bund ul owner's expense.
VESTERN PACIFIC. ROOFING, CORP.
"ontracturs License 0235717
Robin 1.. Winkle
_Project Manager 3/18/03 _
Tille/Ustc '
WESTERN PACIFIC ROOVINC HAS THE RIGHT TO RF_V:IND THIS CONTRACI' WITHIN FIFTEEN DAYS OF
,%CCEPTANC'E, THIS ACRF.EMENT IS NoT WNDING UNTIL ACCEPTED BY THY: OFFICK MANAGEMENT.IT 3462 1A
CAAIPANA WAY. PALM SIORINCS. CA 72262. NO CHANGEN OR AUIHTIONS TO,rHIS A :REE.Nit.NT SIIALI. RF, F.FFF.("Ciel:
L N'I'1L;%r1'12OVF.1) RV WEtiT! 'CC:! NAGEYIE:NT.
M,%N,%GERS ACCEPTANCE:
WFSrM PACW
s
mu I"
APPLICANT NAME (L, F, MI)
DATE
4715�Yr
ADDRESS
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CITYI,WMMONITY STATEIZIP
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JOB SITE AD Re SISPACE
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'CITYICOMMUNITYISTAT )ZIP
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BLDG INSP TOR
FINAL DATE'
AR IE G F RM NAME
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CITYICOMMUNITYISTATEIZIP -
PLAN p
PLANS EXAMINER
APPROVE DATE
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FORM 284.208(11.81) INSPECTOR
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS `
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
1 Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L. E]
43
Final
IDA
Fireplace T.O.
ONON
ADDITIONAL INFORMATION
SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping O .2
17 Rough Plumb
IB Vents
19 Sewage Disposal
20 Sewer
21 Water Heater 6
22 Water Softener
23 Water Service
24 Gas Test
25
Final Lo
Tank Pit L.Line
-SEWAGE
REAR OF PROPERTY LINE
PSL P/
e
V
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME