0105-173 (PLBG)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
400961 C742 2 "' " f, 3 D.N. I/ V
Date A� 4r'/ 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).
O 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.
r I have and will maintain workers' compensation insurance, as required'by
ecton 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 Policy No.
M RI%j`t,ND 1371202-9.5
(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.
Daterr �w97 APPlicant i',� 1 "w`
spy. `�.✓.R•'' s ��-•�""'-
W(r-ning: 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
19!,inspection purposes.
"Signature (Owner/Agent) 4%_ "� -•-� �--u Date5 f t t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT�;..'],� TRACT `
Q✓� �[ �y�]
1.Nd..1.10100
JOB SITE
APN
ADDRESS
77-929 UA00DRIVE
OWNER
CONTRACTOR / DESIGNER / EN &NEER
DAVID .& UL
Fromo SEVhR sEkif'3:CF
77.929D91VE
8401�MWON :
IA QT'/MA CA 92753
PALWOJESERT CS 92261
(619)346-7793 > V~ A 342
USE OF PERMIT
W ; ik?;W L99011.YYt11r MR
Iii��3.,'1"�a t3a��1:�`iI�:G•N`l° i'�.�.�9 a .
V!s IAI ATI ON 2,5 0 0, M t.
kwtwmcosy ap commucnox
101-000-419-000 V2.59
a
FMAY 1 5 2001
F
CITY OF LA 601 NTA
,
FINANCE DEPT
IX61! P= -PX O
$(.3.00
RECEIPT
DATE
BY ,,,�'"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION I DATE I INSPECTOR OPERATION DATE I 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. Y
Framing Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wail Insulation Condensate Lines -
Party Wail 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
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 APP iROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
' moke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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SEWER CONNECT 131D FORA
CUST.
ADDRESS:
CITY
DRAWING: (OIIOW'fANI(, PIT AND LATERAL LUCAT1.ONS)
0.0UNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
Food -, Sgwage Disposal
Trailer Park Q'�' f 000 Gal. Septic Tank
Motel, Apt., Hotel _,D06 Sq. Ft. of Leach Line
Dv,c-fling eT i5'6--.4_,fvJo. Dia I (0 ( BI TD MD Seepage Pit
Commercial Building !Connection to Sewer
Swimming Pool _ Connect to Existing S.S.D.S.
�No on -sits regenerating water softening discharged into the individual sewage disposal
Xsystem herf:with ap!sroveci without clF a.> -' „ , .. ;4; iNaier Quality Control Board.
bVater supply serving this instal!
a?ion «r; ; : . I ;;. ,Y ;roved source
?� AA swuvage disposal installation must r. ;- :c_'.;ire „rants of current Uniform Plumbing Code.
Ary cutting, grading or filling in nuillfy sewage disposal approval.
Approval has been obtained from the Quality Control Board for installation of the sewage
disposal system.
This is to certify that the Riverside County &ivircnmental Health Services approves the subsurface sewage
disposal plot plan to obtain building permit In" installzi ion, ction.
DAI 1-7: S — I 1 —(0 \ �q &�
BY
\ ; .. ,. (2 3, )i U n
Ciel, n le��� I;�� 4' \r1 6 6o�c ; v�P1°•��c�
no+- lse- �n5i a�le� v�clu �o>Jrr� svrFa�e��Cr;vt�,�JSt Co�t�,,v.,�s
b\C
LANDSCAPING—FENCE—WALLS?
HAND DIGGING REQUIRED?
IS "FALL" UK?
ANY CEMENT WORK?
DACKIIUE ACCESS
EC SEWER SERVICE, INC.
dba ECONO SEWER SERVICES
P.O. BOX 192 • PALM DESERT, CA 92261
(760) 346-2793 (760) 328-7760
JON MORE ORDER
14567
PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 11/2% PER MONTH CHARGE AFTER 30 DAYS.
DESCRIPTION OF WORK: -- /
CONDITION OVTANK BEFORE SERVICE
Good _ Trash & Garbage _ _ Excessive soap
Fair _ Overflowing _ Sand
_ Poor _ Blockage _ Repairs Needed
Very Poor _ Odor
Roots _ More frequent service needed
A". ��1 �•-l' .. � X% Z'
FAX (760) 347-4978
DATE OF OBpE��
DISPOSAL FEE
TOTAL LABOR
SERVICE CODE
PLEASE PAY FROM THIS INVOICE. NO STATEMENT WILL BE MAILED.
PHONE
TECH N
HELPER
STARTING DATE
BILL TO
$
TYPE OF WORK
❑ CLEAN DRAINS
ADDRESS
❑ OTHER
-�
❑ SEPTIC TANK
❑ GREASE TRAP
CITY
❑ SEEPAGE PIT
JOB NAME AN
LOCATION
ADDITIONAL WORK NEEDED:
TANK SIZE:
PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 11/2% PER MONTH CHARGE AFTER 30 DAYS.
DESCRIPTION OF WORK: -- /
CONDITION OVTANK BEFORE SERVICE
Good _ Trash & Garbage _ _ Excessive soap
Fair _ Overflowing _ Sand
_ Poor _ Blockage _ Repairs Needed
Very Poor _ Odor
Roots _ More frequent service needed
A". ��1 �•-l' .. � X% Z'
❑ No one home 110 Total amount due TRI billing to
Signature above work: or be mailed after
1 hereby acknowledge the satisfactory completion completion
of the above described work. of work
TOTAL PUMP
DISPOSAL FEE
TOTAL LABOR
PLEASE PAY FROM THIS INVOICE. NO STATEMENT WILL BE MAILED.
TOTAL MATERIALS
DAT OMP TED
WORK DE ED BY
TOTAL AMOUNT
$
❑ No one home 110 Total amount due TRI billing to
Signature above work: or be mailed after
1 hereby acknowledge the satisfactory completion completion
of the above described work. of work
WESTERN PAC IC
Roofing Corpoi ation CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
October 2, 1997 ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
Mrs. Kibler
77-929 Lago Dr.
La Quinta, CA. 92253
AND ALL APPLICABLE CODES
RE: Re -roofing Project; 1 Z �,
Application of a Polyurethane Foam and Acrylic o BY- wa P�� µ.ti
Application of a U.S. Clay Tile Roofing System.
Dear Mrs. Kibler,
Tank you for the opportunity to inspect the roofing system on the above referenced property. Having
done so we are pleased to submit our recommendations and proposal for the installation of a polyurethane
roof system and the installation of a U.S. clay tile roofing system. The recommended scope of work and
associated costs are as follows:
GENERAL
Unless expressly stated to the contrary, the contractor shall be responsible for performing the following
acts.
DESCRIPTION
A. The general 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,
insurance certifications, etc., to perform all operations required and specified. The contractor
shall provide labor and material customarily included in work of the same nature to give a quality,
complete job.
C. If unexpected conditions are encountered during the work, and the conditions adversely affect 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
not authorize or permit any other person to use said premises for any purpose whatsoever.
Western Pacific is to be given all reasonable set-up and staging areas.
3462 La Campana Way • Palm Springs, CA 92262 • (619) 416-5877 • Fax (619) 320-8912
Mrs. Kibler
Pagel
E. Contractor's scope of work shall not include the identification, detection, abatement,
encapsulation or removal of asbestos or similar hazardous substances. 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 jobsite 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 jobsite until such products or materials, and any hazards
connected therewith, are located and abated, encapsulated or removed, or it is determined that no
hazard exists ( as the case may require), and contractor shall receive an extension of time to
complete its work hereunder and compensation for delays encountered as a result of such situation
and correction.
SURFACE PREPARATION (polyurethane roof system)
A. Removal of the roofing aggregate shall be by brooming or power vacuuming. The existing gravel
surface will be vacuumed, swept and vacuumed for proper surface preparation.
B. Install new 26 gauge bonderized metal around roof perimeter (unpainted).
APPLICATION OF POLYURETHANE FOAM AND COATING
A. Remove any contaminants that will interfere with the total adhesion of sprayed urethane foam to
the substrate. Surface shall be free of loose particles, rust, scale, grease, direct latent moisture, old
roof or other contaminants
B. Roof deck shall be primed with Neoprime primer at the rate of .33 to .50 gallons per 100 square
feet.
C. Urethane foam insulation shall be sprayed -applied to a nominal thickness 1" (plus or minus 1/4
inch) over the entire roof surface. Only 3 lbs. density foam will be used in this application.
D. Coating shall be applied in a minimum of two (2) separate coats. Acrylic coating to be 60%
solids, ( plus or minus 2%).
a.. The base coat shall be applied at a rate of 1.50 gallons per 100 square feet.
b. The top coat shall be applied at a rate of 1.50 gallons per 100 square feet, yielding a total
system thickness for both coats of 22-24 Total Dry Mils.
C. During the final top coat application, size #11 granules will be embedded into the wet top
coat material at a rate of 50 pounds per 100 square feet. The top coat color and granules
will be gray.
d. All foam is to be coated. Coating shall extend up and over all foamed vent pipes and
terminated a minimum of 2 inches above the foam, creating a neat appearance, self -
terminating flashing.
WESTERN PACIFIC
Rwfwg C -P-- n
Mrs. Kibler
Page 3
This specification meets manufacturer requirements, Underwriter Laboratory
specifications and ICBG compliance. This system,, when applied over an existing fire -
rated Class A or B built-up roof system has a UL 790, A classification. When applied
over an existing C rated roof system, the existing rating remains. RTC ICBO # ER 4630
POLYURETHANE FOAM COST: 53,600.00
WARRANTY
A Five (5) year labor and material warranty -will be issued upon completion of the roof and final payment
is received.
INSTALLATION OF A U.S. CLAY TILE ROOFING SYSTEM
PREPARATION -TEAR OFF
A. Remove all existing shingle roofing, and composition base flashing.
B. In the event that roof removal or "tear -off' is a part of this specification, all old roofing will be
removed down to the sheathing, with the exception of that material so firmly fixed to the
sheathing that continued attempts to remove it could damage that.sheathing. Under this condition,
the material will be left in place.
C. The exposed roof deck sheathing will be examined. Where sheathing is defective and when
authorized by the client's representative, remove and replace defective sheathing at a cost of
$45.00 per sheet or any portion thereof.
D. Clean roof of all debris.
APPLICATION OF
A. Install two layers of #40 organic base felt underlayment mechanically fastened.
B. Install new edge metal around the perimeter of roof (unpainted).
C. Install galvanized roof flashings as necessary.
D. • ' Install U.S. Clay tiles to manufacturers' specification.
E. Install U.S. clay bird stop.
F. Install aluminum secondary flashings in conjunction with the tile installation.
G. Install mortar at hip and ridge detailed areas.
H. Install matching hip and ridge tiles to manufacturers' specifications.
U.S. CLAY TILE COST:. $9,825.00
WESTERN PACIFIC
RenMB �
Mrs. Kibler
Page l
CONTRACT AMOUNT
POLYURETHANE ROOF SYSTEM...............................................53,600.00
l . .............59.825.00
TOTAL CONTRACT AiVIOUNT: 513,=125.00 Initial
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 approval of the contract. Balance due upon completion and paid within 10 days of
receipt of the invoice.
The price quoted has been structured to reflect standards we assume are mutually desired: quality
installation, service reliability and long term performance. The price may be subject to change 15 days
from the date of this proposal.
If you are in accordance with the conditions herein and the General Conditions enclosed, 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.
NOTICE TO OWNER
Contractors are required by law to be licensed and regulated by the Contractor's State License Board.
Any questions concerning a contract may be referred to the Registrar, Contractor's State License Board,
P.O. Box 26000, Sacramento, California 95826.
ACKNOWLEDGMENT: Owner acknowledges that he has read and received a legible copy of this
agreement including all terms and standard provisions before any work is performed and that he has read
and received a legible copy of every other document that owner has signed during this negotiation. Uwe
hereby acknowledge under the penalty of perjury that Uwe am/are the legal owners and am/are authorized
to sign this contract as an agent of the legal owner.
ACCEPTANCE: The above prices, specifications and conditions are satisfactory and are hereby
If accepted. You are authorized to do the work as specified. Payment will be as outlined above. You,
the buyer may cancel this transaction at any time prior to midnight of the third business day after
the date of this transaction. See the attached Notice of Cancellation for an explanation of this right.
Owner has the right to require contractor to have a performance and payment bond.
HOMEOWNER
Authorized Afent
WES PACIFIC ROOFING, CORP.
Authorized gent
— 9 — c07 D,4vc L,,a w!P, &-,-A /0-247
Date Project Manager Date
WESTERN PACIFIC ROOFING HAS THE RIGHT TO RESCIND THIS CONTRACT WITHIN FIFTEEN DAYS OF
ACCEPTANCE. THIS AGREEMENT IS NOT BINDING UNTIL ACCEPTED BY THE OFFICE MANAGEMENT AT
3462 LA CAMPANA WAY, PALM SPRINGS. CA 92262. NO CHANGES OR ADDITIONS TO THIS AGREEMENT
SHALL BE EFFECTIVE UNTIL APPROVED BY WESTEMN PACIFIC MANAGEMENT.
MANAGERS ACCEPTANCE: DATE
WESTERN PACIFIC
Rmf-9 Carya+ —