0205-219 (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
4'71/50 8/31703
Date • 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.
( ) 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 4; ATE FUND Policy No. )642419-01
(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. r"
Date: - .- Applicant-
-Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person ai.
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) -^ " "''— Date -
`_BUILDING PERMIT PERMIT#
0205-219
DATE , , VALUATION 41 LOT TRACT
JOB SITE ADDRESS �V-16 AV 1 .��► RWiO APN y
OWNER CONTRACTOR/DESIGNER/EN (NEER
RCM-NA,14F..E�,`ii`E: S Pl.i. M x` "J: COWRAC".' W° s &.R009,1NIC.
.5 4-15 5,AV17MA RUM '79.805 TRUMAD.
1:. A QpaTTTA CA - 92253 BEWRMUDAD PITIES CA, 92201':
/EiC1,346.2420 C 7,�$ ry:�2
USE OF PERMIT
CsMLM, BUILx.19011.
RAXA '001P WITH OWNS CORN tNO 01MENSl.OI1.FaL StiP.PlOLM
VAIXATION
31'M5.00 "0
3t"c�MMA11D €' O -W 01P CC1,11MUC:".£°>:ON , 3,845,00
P> RM. 11 ITE SUKii/f�. 'M r
HE -ROOF JIM 1 iii Ui1flQk4 a �d�4Ft?�7 ��A UQ
s
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D lei DB} 1;ti i. C . M1,014 AMD F'L�.M C-11WK. K. $30.00
Lr -u 7 1AMIMPM-PAD MYS S0100
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CITYOFLAQUIRkTA
FINANCEDEPT.
DATE
Ft
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE f
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
_
Roof Deckr �Oo�
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 J
Party Wall Firewall
i
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
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
I
Gas Test
Appliances
Final t
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
t
'
L 2' P
PALM DESERT CONTRACTORS/ROOFING
P.O. box 2795 Palm Desert Lic4477507
California. 92261
760-346-2420
DATE: 5-17-02
PROPOSAL submitted to:
Rowena Beavers
WORK to be performed at
54-155 Ave., Rubio La Quinta Ca..
Palm Desert Contractors/Roofing hereby proposes to furnish and perform the labor necessary for the completion of,
Total removal of existing roof and reroof as follows, Pitch section: install 15 lb base sheet, Install 30 year
warranty Owens Corning dimensional shingles (desert tan) . Use standard metal. Paint all roof jaxs. Flat section:
Install 28 lb base sheet, Install American Modified tar commercial roofing membrane, use standard metal. Remove
swamp cooler, cover hole with plywood.
Extra: permit, plywood @ $30.00 per sheet, extra painting.
The work will be performed in accordance with the drawings and specifications submitted for above work and
completed in a workmanlike manner for the sum of: $3845.00
With payments as follows; 0 down payment
Balance upon completion
Respectfully subr
ACCEPTANCE OF PROPOSAL
The aboypT ce,-specification and conditions are satisfactory and are hereby accepted. Palm Desert Contractors/
Roofing is aut mrizcd to do the work as specified. Payment will be made as outlined above.
Date: �� ' Signature