BLDG (9903-311)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
447139 I3 C,39// 10/31/129
/Date �� Signature of ContractoP,�N°"��
OWNER -BUILDER DECLARATION
I 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.
( ) 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 ( { y ry Policy No.�IT
(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 provis ons. fi
D�afe: '✓ :�i/�! APPlicanty A -A, -(X,. %/ %f �jr� .
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 authokize representatives of this City to enter upon
the above-mentioned property for inspection purpeses.
§ignature (Owner/Agent)(/-1t" ate
BUILDING PERMIT PERMITN01
DATE Milt" VALUATION 4.61)0.0() LOT TRACT +�s��
JOB SITE APN
ADDRESS 51455 ANi..NIDA NEiVE1!,li>+ATR.O _ a•
OWNER CONTRACTOR / DESIGNER / ENGINEER
MNI 1. 13 T) m,,P vALI,Fy, C{3N5'T..&ROOFING
511353 AVENIDA NAVARRO 594 W. 7r.H S13t.k ET.'
LA Q1JIVfA CA, 93253 SAN JACIN.10 CA 9258t
(99)654-1.931} C13L# 775
USE OF PERMIT
GENERAL BUi'Li.11i O
R&R00%,1": MOVE i \VO IaMS1I"1NG I.MMRS Billl.T UP ROOFI NND
RVJ,AC E idu'ITI-' ),131TT u'1d;C Iff C.'i .A:YU T'T?'Y':ffX JC HO 3$23
`VALt.1Fi.rI074
4.600.M LS
ES4Iilta,.lVVD9 CONT 011k. -I
PERMIT FEE SI3iV1MAWV
-RERa:: OF .FEX 101-000-418-01V �530.i1U
�N
SI1-KMAT.. CON"Nd A KMON AN13 I>i; AN f.':flli('34- ifl SNi
LESS PRE -IR x.10 IFI -I ,^S VIM
'Ct)'J'AL P.IKUP D8T .UMS DUE i'+iOlti I $30.9111
�1
RECEIPT DATE k (�� BY;f / DATE FINALED I 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 X—(- 79
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 - —
BLOCKWALL APPROVALS
POOLS - SPAS
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
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:
C/
Beautiful Real Clay Roof 'Tile
Traditional Mission Style
"S" Profile
Transferable Non -Prorated
Lifetime Limited Warrantu
with FADE Coverage
Class "A" Fire Rated,
WILL NOT BURN!
True Lightweight Desigr
Under 6 PSF
te Enhanced Resale Value
ze Low Cost -Per -Year
Competitive information from Committee for Fire -Safe Roofing Study, February 1994
Your Source for Claylit& is:
Aute:cntic clay i2oofing 77f[e
3 .''
T
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< �� �7� A
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Six Beautiful Natural Colors
colors depicted may vary from actual colors due to the inherent variations in natural clay products
and the limitations of the lithographic printing process.
The concerned parties should examine actual color samples, at both the time of initial color selection
and once again from the delivered production run prior to installation.
.In order to avoid any possible unwanted color patterning during the installation of blended colors,
the skilled installer should periodically view the roof from ground level at a distance ofabout 50 feet.
This procedure will help ensure the desired random look, and help to avoid "hot spots,"
checkerboarding, streaks or stairstepping. Acceptable blending cannot be done at the factory or on
the ground. It can only be done as the product is installed.
:1: ;!r k- c11 J
909 West Railroad Street • Corona, California 91720. • FAX: 909/734-9591 • PHONE: 909/737-0200
http://www.ustUe.com/clayinfo
0 1995 aunt Industries Printed in U.S.& CLOC82 96/35MSEN t.
The Inside Story
supercoreTM
Another of US Tile's advantages,
SuperCore is a performance-,
enhancing feature found in our
darker clay.products. Greater
flexural and crushing strength with
less water absorption are inherent
with SuperCore"'. And because of
our unique kiln -firing process, we
retain much of the clay's naturally
occurring carbon. As a result, our
tile is more environmentally friendly.
Fade -Proof, ;{
Performance -
US Tile products are guaranteed to
meet or exceed the current ICBG*
strength and water absorption
requirements for a lifetime.
Additionally, we guarantee our tiles
will not fade, streak, blotch or
effloresce. Because the color is
integral to natural clay tile, it is.
unaffected by the sun's powerful
UV rays.
* ICBO Report Number 3523
And Then There's Sawdust
and Cement...
Among the products touted as fire -
safe alternatives to clay are those
made of pressed wood fiber and
cement. They are not warranted
against fading and efflofescing,
and may require sealing and paint
retouching after installation. .
In addition, most of these products
have been on the market for only
a few years; so no one really knows
how well they'll perform over the
long term.
It's easy to see why your best choice
is the natural choice... real clay tile
from US Tile.