0305-124 (RR)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
x.35117 C•39 S -mc 11. 113112(
W, 'i'
Date � � a �--+T 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&RC. 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.
(q )' 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 `)xA�"s"I � � Policy No. 04$76 (14-02
(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 provrsions7 ,
Date: <'-►+-<-Applicant l
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.
0 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 ppuu�rposes.
Signature (Owner/Agent).. •��✓"�'��-�`� Date_
BUILDING PERMIT PERMIT#
03M-124
DATE (�yam�/f ��pqqp VALUATION ��QQ �e� ��jjpp�� LOT TRACT
i�Jl,�fl. 0C V,632.00 -
JOB SITE
ADDRESS �wr� 'TA(34
f ' ,
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PAMELA T..ZE
? 9i iti 11"A{` e R-0 OFDro.
78-108 LAPID D?j. R "
346.2 1A CA!tlLi AN'.l9.VAT
L& QUIMA CA 92253
Pia;.=M L��:3I WS CA 92262
CT60)416;5877 CDV� 4293
USE OF PERMIT
�
V �.:.+Gvb:crL6A•e6r .6:iG�1l.rT..YJdV, ®'
�i
12.L� kOOP 4?nTH POLYt RZTHANE VC1AM &COATYNO SYSTEM CLASS '
VW)A' ION 4,632.00 LI
i MA MM, COST OF CtINFIrMu - ON
1PIi Jf a9.d &MMIkuy
.
1tEROOF 17101, 101.000.418.000 $30,00nD
I
MAY 12.2003
'CITY OF LA QUINTA
8 _ F#fV .1C Fft ONXML' CfCC,Cf,'.
$30.00
LESS P1 �i'Alis 'F
$O.PO
'COTAL+ PE 1gf .1 FEIVS DUE NOW
�3CB.EPi3 '
RECEIPT
DATE
BY
DATE FINALED
INSPEC
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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings i
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:
,
/
4 - '
May 02 03 03:23p Rick—Lee
rev Jeu bwlt e;
\WESTERN PACIFIC
Roofing Corporation
Since 1949 Lic. 1/235717
Aliril 16. 710.3,
Puutela Lcc
78108 Lagn Dr.
La Qulnta, CA 92253
760-777-9220
Apr -16-P"-, 7:43i
i
RE: 781119 Largo Drive, Ln Quiou. CA 92253 (Flat roof areas ouly)
Application of a Polyurethane Fonm and Acrylic Coating Koofin` System.
I )err Mrs. Lee:
Thank you for the opportunity to submit ; pruponal for the re -fooling at the above referenced property. We
are plea,cd to submit our recommcndationa and propxasal for the installation of a pulyurexhane rout' ystetn.
The recomancradcel stole ul'work and iissociated cults ire as follows:
GENERAL
Unless expressly st:alud to the conuary, the coatlractur shall he responsible for pertanning the: fulluwin;;
acts.
DESCRIPTION
A. Tlnc general cuuditions of this standard cunstructiott enntr act Yhail form a part of these
spc6l'i"tions with the same lince and effort as though repeated herein.
-- IL The contractor shall runtish all labour, materials, equipment, pennits, contractor', liccnxa and
insuranex eertifrealionr to perform all operarions required and specified. Tlic cuottractor shull
provide labor and materiul customarily included in work tafthe same nature: to give a quality,
complete joh.
C. If unexpeclud conditions arc encountered during the work, rind lite Wnditions adversely afl*Lci the
cent nr progress of tate work, the contractor will notify the owner immediately, and the owner will
raci;,utiote a change -order to resulvu the unexpected e:ort(lition.
U. Thu Contractor shall occupy, usc, and permit others to use the premises only for the pearpost of
completing the work to be performed under this contract with the Owner. Tht Contractur shall
not authorize or permit any other person to use said premises for any purpose whnusuevcr.
Western pacific is to be given nll reasonable yet -up and staging areas.
E. Contractur's scope of work shall nut include the idcntiflcation, detection, abatement.
encapsulation or removal of asbestos or similar hntardou.% substance:s including mold and or
mildew. If Contructor encounters any such products or malcrinls in the course of pe:rfirnning its
work, or it such hazardous materinls ore encounterul by auy uthcr firm penlbrmin6 work at the
johsire and contractor determines that such materials present a huzurd to iec employees, contractor
<hall have the right to discontinue its work kind remove its cnipluyves from tett iubsitc iarail such
products or materinls, and any hazards connected iheruw,th. are hx:awU wad altntal, cncupsulatcd
ur -
3462 l,a ('atnpana Way • Palm Springs, CA 92262 • (760) 416-5877 • Fax (761) 320-8912
www.westpaczoof.cotn • E-mail: wprcps(a3westpacroof.coin
Page 4
p.2
0
May, 02 03 03:23p Rick—Lee
i �/• ..varix, nvurawv, nr.� IOU JYU U912i
I'muclo Lee
�- April I6, 2(103
Paye 2
760-777-9220
Apr- i 6-t�:7:43;
remuvvd, or it is determined that no htrz-1rcl e.xist% ({as the eusc tray ittluire), and [unuacitir hall
icccivc an wellsion uflime to erunplete its work hereunder uuil et►iupenswion l6r delays
encountered ;IS a result orsuch situation and wrrection. With Lilo possible existctice of mold fruin
lire -existing conditions, Wistcrn pacific Ruuling Corp. will not be hold responsible for mold
related claims resulting from mold detected at any little in he 1'uium.
S1!RFACE PREPARATION
A. tiurfhce gravel wiil be removed by vacuuminK-
B. Remove any cnntantinbnls that will interfere with the adhesion of sprayed Itrcthanc loam to the
substrate. Surface shall be free of loustr pauticles.
C'. Ruv1' Jeck Shull be primed with Nooprime prinwr nt the rate of 33 to .511 plloris per 1(10 squurc
test.
1). Install new perimeter edge metal. (Unpainted)
APPLICATION OF POLYURETHANIF Ff)AM AND COATING
A. Urerhnne burn insulation shall be sprayed -upplied to a numinul thickness of 1" (plus or minus 1A
inch). Only 3 lbl. density foam will be titled in this application. Additional loam %vill N ;aided
to the lour areas to help minimici: pondin:;. Some ponding will remain.
u. Coating shall be applied in a minimum of twos (2) separate cuals.
-r. The base coat shall he upplied -a a rate of 1.5(j &illnns lxr I OU square icer.
h. The top coat shall be applied at it rate. of 1 .10 gtillons per 100 squarr fect, yicldio� it iulal
sysitln thickness for both coats ul'22.24 Total Ivry Mils.
C. During the finnl top cool 1pplicatiun, %izc p 11 granules will he embedded into the wet Lill)
coat inateriil) at a rate til' 50 pounds leer 100 square feet. Top cunt Color I.i_ht (;ray•
i1. All foam is to be wnied. Coaling shall extend up and over alt (learned vent pipes :and
terminated a ininihium uC 2 inches above the foam, creating o neat appe"nince, self-
terrninuting rlashinl;�l
11
(I)NTRACT AMOUNT 54,631.00
l�
N(Yl'F; al: The HVA units st he dicctiutected and removed (luring the re-rauatutg process. This
wort: is NOT included in the cunirtict amount.
PA Y MF.NT TERMS
10% deposit upas approval of the ctnttracl. Balance due upon contpletiuu and paid within 10 du}s of,
receipt of the invoiix.
WAKRANTY
A Five (5) year labor and material warranty will be. issued upon completion of the ron► and Imal paymuii
is ru:rivcd.
Wl?3:ISRN PACIFIC
Page 5
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May 02 03 03:23p Rick---J_ee 760-777-9220 p.4
.4.. ., .uu nest nail; Apr -16-p. 7:43; Page 6/10
Painclit Lee
April 16, 20W
Pnllc 3
The price cyuuted has been Stuctrrrccito rellect standards wt ttsstlme are mutually desired: yuality
incrallatron, service reliability and long- Icrnt perfnrmancc. '11tc price may he sub.iect rip chainge 15 days
fixim the date ul'this propusnl.
11' you aic ill accurdanee with iln: cuiedirions hcrern. picirse esccute the agramnent bcltm. and return bull
Ct IMs It, Itis otlicc We will, in tum, si;n them and return one copy to you. '111,utk ytuu liar y,ur
crroperation in expediting (his contract lbr your roofing, needs.
NOTICE. TO OWNER
C.untractnrs art• required by law to be licenscd'and regulated by the Cnntraetor's State License liourd
Any qucsliirns concerning a contract may be referred in the Regish-lir. Cunin3cior's Stitt License [smird.
Y.(). Box 360011, Sacrumento. Califurnin 93926.
ACKN()WLED(:M! NT: Owner ac►nuwltd&es that lic has read and received a legible copy oflhis
.lgreemcnl including all terms;uid standard prnvisiuns bcfurc any wort: is performed unit drat he has rc.ril
and received :s legible copy or every other document that owner has signed during this nc utiatimi. Uwe
hereby acknowledge under the perwlty of per [liar Vwe am/are the legal owners and andare autnorizul
io sign this contract as an tigent of the legal owner.
ACCEPTANCE: 'The above prices, specirications and cuodilions are snli%factory and „re hereby
accepted. You ore out hurized to du the work as sperir)ed. Payment will be os outlined nbove. You,
I le buyer' in 'ancef this transaction el mny time prior to MidniRht of the third huainess day $after
the date of this t ahSeetion. Owner has the 66hi to require contractor in have a perfannancc ;$rid payment
himJ i,[ owner' . exnense.
PAN! F.LX1 LEE
Ab h1irrApUl Agent
I'Ilk
'6 - ;z 3
flute.
WEJTKUN PACIFIC: ROOFING. (:(')KP.
Conlractot'm License P 235717
Itnnnld R. Winlele
_Prujcel Manager___...._
—April
anager__-
_April 16, 2003
tYtal'IiRN P.ACIFIC ROOFING IIAS'1'M RIG11TTO RY.SC'INU THIS CONTRACT WITHIN I'll"r►:Ev a %vs, OF
Acraa•'r:\N4t:, 'rm.S,\(;RR):AtEN'r 15 W)T RINDINt; UNTIL ACClt:rrt:u In"rHE ovviCt: MaNSGt:MLNT a'r
162 LA 4AM1'ANA N',\1', t'Al.el SF tING , CA Y2Z62. NU l'NANGF\ 1)R,\ppIT10NS'r0 T71I:N:\I:RY.ENfNI'
SlIALLfit. 1?FBF(.-Tl'Ct:r'41'IL ri F_tiIENNP Ftt'MANAGF.N►.V'1'.
niANAGEASACCEPTAN(:t:: _ _ uATV �I
WESTERN PACIFIC
a..,c.� c:q..n..
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