0105-210 (RR)x
--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
C 39
ate 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.
(X)I 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 Policy No.
ITTArz� FUND
.;
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) [,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 provisiQAis of Section 3700 of the Labor
Code, I shall forthwith comply with those roti ions. w
D ate:jf Applicant -
1 -7-7-
v t' .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the. conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this,application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance cf such
permit, or cessation of work for 160 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby, authorize representatives of this City to enter upon
the above-mentioned property for inspecti6p purposes.
Signature (Owner/Agent) � Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT !�}�,-, TRACT
JOB SITE
APN
ADDRESS
76 09 f1 Gyyryry, DRy }Jp1
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
78-08 :►:LAQ0 i)X-3VIf
7$-7) 6 AV UE 4.1
'-T kQ7J]1+ATA, CA, 9", 53Gadia'
pilDMa CA 92201
C160)345.847+6 CARIX 4344
USE OF PERMIT
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i H.P.1997 ONIFt.D1M4.X)MYNIS'i'RAT-TiVE C01109 §3K5 FOR WORK BEGUN
k"a'FR'C7OF 1%000.00 LS
ESUMNXED COST 0 MMMCION
10, JFK
$y yAUITE W R .
04VE:3 RIAT )ON IMfi 101.000.4.23.000 SAW
$B.FI•ROOF ArrX 101-000-418-000
a
SM.1'a;5TAT CON8133.LT4'�l ON ;ARD PLPX 0. .CF.
WC0100
ISO PRE -PAID rMes
$0100
TMAL PMW' FEES D11F.14OW
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t i
RECEIPT
DATA 7
/
BY(/
DATE FINALED
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D II - Int. Lath
Final
Final
- 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 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)
.jr-
.... ... .-... T.t Y. ;tl"9iY . Y.. �. :k;, f-ri5.'. .yr T,. ,•J:It "1X^3 4.r'i. "Z -;{u:'. -. •-+z _
' BUCKING WATER ROOFING: COMPANY
"All types of roofing"
,Y 78-716 41st AVENUE, BERMUDA DUNES, -CA 92201 ¢
Bus: (760) 345-8476 Fax: (760) 772-1076° : Lic. # 65-30-13 $
1-17-01
PROPOSAL
SUE- HART
78098 LAGO DR,
L, Q, CA,
HOT MOP 4 -PLY ROCK ROOF TEAR OFF
We will tear off old roof and haul to dump.Next we will
replace any bad sheets of plywood for $30.00 per sheet.
Then we nail 28 -pound fiberglass base.(1-layer) Then we hot
mop 1 -layer 11 -pound fiberglass ply where any metal
flashings or gravel stop is installed,Then we primer
any metal flashings and nail in place. Also we mastic all
joints as we install.Then we mop hot asphalt between each
11 -pound fiberglass ply. (3-layers).Floodcoat to be hot
asphalt and rock. 400-1b per SQ, We also mastic all pipe and
roof vents.NOTE- We will replace all metal flashings (NEW)
TILE DECKS
We will pull up old roof tiles and nail 2 -layers of
4,O -pound tile underlayment. roof jacks will be installed
with 40 -pound under and on top of roof jacks. Valleys
will have 40-1b under valley metal and 2 -layers on top.
We will also 3 -course pan metal to underlayment. Then
we nail each roof tile back in place.And mud where needed.
'NOTES --WE WILL HAVE TO LIFT A,C, UNITS SO WE
CAN HOT MOP UNDER THEM THEN SET BACK IN PLACE
10 -YEAR GUARANTEE
WHOLE ROOF AREA $10,125.00
A,C,-N-GUEST ROOM $6,485.00
MIKE MOORE
ACCEPTANCE
to . D