0110-186 (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
D tiF3'l.M
Date 'f { f Signature of Contractyor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) 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 `u`MM pNKID Policy No. (D(1jM-285-95
(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.
Date':-' A --U / 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)•. Dated</
BUILDING PERMIT PERMIT1.
Qk.1t3..18E
'
DATE VALUATION ,� LOT TRACTJOB
SITE
ADDRESS eef�� tZS@3d�AdCe lsR�dbdd.A"�P}ra
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TU04ARD I`"1"UY,
:iYR0-ITEC.H 14OMWO, Ci?.
w�a'4 i1f s39� a°tiE�t: ..
M.il`7014fC_.13AtfiK .1 Y) 2271 N 185
CA 92253
LA CA
USE OF PERMIT
32LP9;Ck1l�.fJt ,C ,.f°r'tp r��, �.ar.:,sf A- 2621fdC .ASSA. KATZR .AL—S 014L y
RFRO0F LS
WMIMTED
99
j
EOCT 1 6 2001
CITY OF LA QUINTA
FINANCE DEPT:
STPR-TOTAL,t'" NS'€'�.'�MUD'9'�3'.t M P ASCIMCK.
'%36.001
YZso FP.*C.PJW :!! &U
$0,00
TOTAL YMM.—IT YM ME ffOW
00.00
rr
a
RECEIPT
DAf7E /
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 �QcLtj'D� S7
O.K. to Wrap
Exhaust Fans
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
BL'OCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
•a
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)
PRO -TECH ROOFING, INC. PROPOSAL
78-670 HIGHWAY,111 SUITE 185
LA QUINTA, CA 92253 ; DATE PROPOSAL#
(760)360-8099 _ '9/24/2001 468
LIC.# 741152
• r t�
�1
.JOB ADDRESS
152-940 REMERIZ'LAQUINTA
i
DESCRIPTION TOTAL
f REROOF W/ LG WT FLAT TILE
1. REMOVE ROOF TO SHEETING, REPLACE ALL, NECESSARY PLYWOOD @ $35.00 PER
SHEET. ,
2. IXr STALL ONE PLY #40 LBS FELT NAILED TO SHEETING OVER TILE DECK AREAS.
3. INSTALL ALL ROOF METALS AS NEEDED TO COMPLETE JOB.
5. S'T`ACK TILE AND TRIM ON ROOF AND INSTALL AS PER ROOF SPEC. t
6. C6;EAN UP JOB AND PAINT ROOF JACKS TO MATCH.
5 YEAR WARRANTY
Thank you for your business.
David Krastel, President: 4'
TOTAL K -
i THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY
ACCEPTED. YOU, ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE J
AS OUTLINED ABOVE.
SIGNATURE ,