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LICEASECINNTRACTOR DECLARATION
I hereby affirm under penalty'of*perjur-y 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
✓ ` �. io
Date ''a'A` Signature of Contractor
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.,P
'04 1 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 ;)Ts+ . E Fi?" D Policy No. 295-0 MOT DO 06
(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,4-shall forthwith comply wftfi 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
the above-mentioned property for inspection poses.
Signature (Owner/Agent)).•" ! - _-.—,,,Date
BUILDING -PERMIT PERMIT #
DATE k 2111k ,, VALUATION &41 LOT TRACT
JOB SITE
ADDRESS eaY?k'e 4'. I'►�!@ £;�::TIKAY� r __?PN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WNE SAI)1w3"
TP. STAR AR I:OU CO.
53-O�..51i`
NMI t:�;0.y��:SUg47...A
79
CA 912201
(760)345-3525 CV -4 I M9
USE OF PERMIT
t:1..9FY.PV, N:3IL SING
R9,:,k00P fldi `= AWD 0A GE `WDA 20 Y11,tiR.1.AMIAt'TKO SY•fNOLFrS,
CLAS "Ag MAMMA1118 ONLY.
1�"6s".C:i .,V"�,�.? COST OF 00.14;` M.MMI
4,6Dalr11'P
�tfi, ticx FE9 TIA100
DEC 18 1002
CITY OF LA QUINTA
FIN CE DEPT,
REC PT DAT / /~
BY
DATE FINALED
INSPECTOR
/,0
n 40-1•
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 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
1`Vater 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:
4
ESTABLISHED 1923
State License No. 715997
L.A. STAR ROOF CO.
79-130 CLIFF ST. BERMUDA DUNES, CA. 92201
PH: 760-345-3525 FAX: 760-345-4439
FAMILY OWNED SINCE 1932
Bermuda Dunes: 323-292-8145
DATE:
12/17/2002
TOTAL PRICE OF JOB: 0 $4,500.00
JOB ADDRESS:
53-025 AVENDIDA CARRENZA
DEPOSIT: $1,500.00
CITY:
LA QUINTA, CA. 92253
COMPLETION Or JOB: $3,000.00
CROSS STREET:
COLOR: WHITE
HOME PHONE: 909 -376 -8341 -
OWNER:
DIANE STORMS
BUS. PHONE 760-777-9913/CRYSTAL
ADDRESS:
CELL PHONE: 760-578-9921/CRYSTAL
EST 4:11021.02 CONT.#
WE AGREE TO FURNISH LABOR AND MATERIAL ON THE JOB ADDRESS LISTED ABOVE AND PERFORM THE SAME ON THE ITEMS LISTED BELOW:
ON ALL PITCHED SECTIONS OF THE HOUSE AND GARAGE:
1. Tear off roofing to the sheeting & and haul away. Install canvas around the perimeter if necessary to keep debris out of the lawn.
Note: The charge for tear off is based on the estimated number of layers to be removed. if there are any additional layers over the
estimated amount, it will cost $25.00 per layer, per 100 sq. Ft. to remove and haul away. The maximum number of layers per the
building code is 1 on commercial, 2 or 3 layers on residential depending on the building dept. The maximum number of layers to be
torn off on your roof is 1.
Wood replacement: We include 20' of 1'x6" sheeting board or 1 piece of %2" O.S. board free of charge. if any wood over and
above that has to be replaced it will cost $2.00 per foot for the 1"x6" or $40.00 per sheet or $25.00 per piece. Any specialty wood will
have to be quoted
2. Remove any bad vents and replace with new vents as needed. Also replace all of the roof jacks where possible. .>
3. Install 1'/z'x 3" White metal edging to all edges.
4. Install one layer of 30# base felt nailed on.
5. Install Owen Corning Classic, 20 year warranty, Class A fire rating, 3 tab shingles. Install 30# felt to any valleys for added protection.
Install shingles through the valley of lower section. Install shingles through the valley from the other section, chalk line & cut valley.
Leave %4" to 3/8" overhang on all eves and rakes to provide a proper drip edge per manufacturers specifications.
6. Install Modified Asphalt roll roofing behind all chimneys and large A/C ducts to provide a longer life to the roofing in this area. .
7. Install individual hip & ridge shingles to all hips and ridges.
We will obtain any necessary permit fee's if desired or required for $85.00 plus the cost of the permit which is usually around 1% of the contract price.
NOTE: ONLY THE BASIC SPECIFICATIONS WILL BE DONE UNLESS ANY OPTIONS ARE INITIALED.
OPTION (A) FOR INSTALLATION OF A 30 YEAR LAMINATED SHINGLE.
1. Install Owens Corning Oakridge 30 year laminated shingles in place of the 25 year 3 tab shingles specified above.
2. Install Dura -ridge shingles to all hips and ridges in place of the regular hip and ridge shingles.
THE PRICE FOR OPTION "A" IS $315.00.
NOTE: WE ARE CURRENTLY A LITTLE SLOW AND TRYING TO GENERATE WORK TO BE DONE WITHIN
THE NEXT 2-3 WEEKS. THE ABOVE PRICE INCLUDES A 10% DISCOUNT FOR CONTRACTS RECEIVED
WITHIN THE NEXT 2 WEEKS. THE NORMAL PRICE FOR YOUR ROOF IS $5,262.00.
PAYMENTS: IF YOU DESIRE TO HAVE THE 90 DAY PLAN THE PAYMENTS WOULD BE AS FOLLOWS:
PRICE $4,500.00 + $144.00 SERVICE CHARGE=$4,644.00 TOTAL PRICE WITH PAYMENTS. DOWN PAYMENT:
$2,244.00 AND 3 MONTHLY PAYMENTS OF $800.00 DUE 30, 60, & 90 DAYS AFTER COMPLETION OF THE JOB.
���� .��� �� - :n •. ••r no..• .nnff«oo of nhnrrtn fnr S —arc fnr rwucnc rinv M Inhnr 9nd matPrialc on the arrac R• items wP worked on oniv.