0307-291 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cN W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
w�
61 0537 C39 11G 01/31/2(
oZ Date } 11 Signature of Contractor y_
J U C OWNER -BUILDER DECLARATION
HUJa I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
CL
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (l ). I have and will maintain workers' compensation insurance, as required by
OU Q Se tion 3700 of the Labor Code, for the performance of the work for which this
LO H permit Is issued. My workers' compensation insurance carrier & policy no. are:
cb z Carrier FIRST ANERICA0 3T Policy No.
a� � Teal 0227A2291
�d
J(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
3 Code, I shall forthwith comply with those prdvisions.
Date: l I `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*
BUILDING PERMIT PERMIT#
DATE 07/2=(KVALUATION LOT 0307-291 TRACT
JOB SITE APN
ADDRESS V-265 AVENIDA C.ARIiANZA - -
OWNER y� T� �y r� CONTRACTOR/ DESIGNER/ EN IINEERRp 190
ME
53-265 PeVW.IDA CAMQ4 A 74.980 RUNAWAYPAY DIL
LA 01 II3TA CA 9225:3 WERMUDADUM7 CA 92211
(160)200.0811 CRI,44 1420
USE OF PERMIT
GENnAI.. x3t3I1 DR4 Ci
RIP. -ROOF 5, fTV.. CLAIE5 "A* MATERIALS
V.4%UATIO}I
7,5114100 U.
ESrMA!rXD CO,S'I' OF CC"IV'S7' UCT10N7,sw o
REROOF FEK 101.000.41.8-000 130, cc
MM-T'OTPA, COQ" TJC",°I'I1� 14 M D PLAN E(.''1 $X00
n LEGS PRE-PAMMM, $0.00
ID_� � PEER TIIr KXS IME NOW ;�3O.00
JUL 2 2 2003
ITY OF LA QUINT
RECEIPT (DATE '' `/ '� BY �' [. IDP,,INFINAL,E4 I INSPE pry/
INSPECTION R_ CORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION
DATE
INSPECTOR
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
POOLS
Steel
- SPAS
Final
BLOCKWALL APPROVALS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
R
-
APPROVALS
_
Final
PLUMBING
Waste Lines
Gas Piping
Gas Test
Electric Final
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
Temp. Power Pole
Underground Conduit
APPROVALS
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)
m
ROOF TILE SPECIALTY
P.O. BOX 11257 PALM DESERT, CA 92255
PH: 760-200-0811 FAX 760-200-0801
LICENSE # 810537
CLIENT: PAGE QUILLING
ADDRESS:
CITY:
PHONE: FAX 839-0447
ESTIMATE
DATE: 6-19-03
ADDRESS: 53-265 CARRANZA
CITY: LA QUINTA, CA
WE PROPOSE TO FURNISH THE FOLLOWING MATERIALS AND PERFORM ALL LABOR TO ROOF THE ABOVE SITE:
REMOVE EXISTING ROOF TILE AND STACK
INSTALL NEW PLYWOOD STARTER AT PERIMETER OF RESIDENCE (NON -PAINTED).
INSTALL NEW 40# TILE LINER OVER ENTIRE ROOF.
RE -INSTALL. EXISTING TILE TO MANUFACTURES SPECIFICATIONS.
REPLACE ALL BROKEN TILE WITH NEW (TILE MAY NOT MATCH EXACTLY TO EXISTING COLOR).
ROOF PRICE: $ 7,500.00
ATTENTION
SECTION 7018 OF THE CONTRACTORS LICENSE LAW PROVIDES THAT STARTING JULY 1,1966, EVERYONE LICENSED BY THE CONTRACTDR'S LICENSE
BOARD SHALL GIVE A COPY OF THE FOLLOWING NOTICE TO THE PAYER 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, ANY SUBCONTRACTOR, LABORER, SUPPLIER OR OTHER PERSON WHO HELPS TO IMPROVE YOUR PROPERTY
BUT IS NOT PAID FOR THERE 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 REMAINED UNPAID.
ROOF TILE SPECIALTY AGREES TO FURNISH ITS REGULAR FORM GUARANTEE FOR FIVE EARS AFTER COMPLETION OF ITS SAID WORK. SAID
GUARANTEE TO COVER DEFECTS IN MATERIAL AND WORKMANSHIP ONLY AND NOT EXTEND TO DAMAGE TO DAMAGE CAUSED BY THE ELEMENTS,
OTHER UNUSUAL ACTS OF GOD AND SHALL NOT COVER ANY LIABILITY FOR DAMAGE TO INIERIORS FIXTURES, DECORATIONS, WALLS, CONTENTS
OD BUILDING OR OTHER PARTS OF STRUCTURE NOT TO DAMAGE OF FAULTY'CONSTRUCIION TT IS ALSO UNDERSTOOD AND AGREED THAT THE
ABOVE GUARANTEE SHALL BE MADE AND REMAIN ONLY WHEN AND F PAYMENT 1S MADE AS AGREED IN THIS CONTRACT.
WE ARE FULLY COVERED BY WORKMEN'S COMPENSATION AND LIABILITY INSURANCE. CARRIERS NAME S AND POLICY NUMBERS ARE AVAILABLE
ON REQUEST.
ANT ALTERATIONS OR DEVIATIONS 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 DATE OF ESTIMATE AND IS BASED ON FREE ACCESS
TO BUILDING FOR DIRECT LOADING FROM OUR TRUCK
ACCEPTED: RESPECTFULLY SUBMITTED BY
DATE ROOF TILE SPECIALTY
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