0110-293 (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 J Exp. Date
/��' I..
Date/ ��
/Signature Signature of Contractor I. „
r 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.
(,)p I have and will maintain workers' compensation insurance, as required by
Skcvtion 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 ff,&°Yj? BUND Policy No.
(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,1 shall forthwith comply with those provisions.
Date: r i �i')/Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subjec{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 applit
correct. I agree to comply with all
construction, and hereby authdriz
the above=mentioned propert for,
Signature (Owner/Agent); L,
:at+on and state that the above information is
p
and State laws relating to the building
resWintatives of this_City to enter upon
cti�iurpo.ses~'
/. Date '�< 2_ ,( t
BUILDING PERMIT PERMIT#
DATE of VALUATION LOT e r TRACT
;;�i°4aMUMtom, IDSA RkiiZ M7.
OWNER
'RODEP.! EDttIKE,
LA QW -ITA I'— CIA 92233
USE OF PERMIT
GEM. LHU1#:,DING
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APN 774 -12Y2 -W4
CONTRACTOR/DESIGNER/
eta?f3FTEX RP-':°] AIZY
74-980 RUNAWAYBAY DX
BERMUDA DIMES CA 9 a 211
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RECEIPT DATE f / 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
O.K. to Wrap
CO_� �� C
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 ll� ��
BLOCKWALL APPROVALS
Final
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 "
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
f, ELECTRICAL APPROVALS
T6mp. Power Pole
_Underground Conduit
,Underground
Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
1%. C) I t Z, -12_� 5 ' �6 1��
CONTRACTORS STATE LICENSE # 636391 P.O. BOX 11257
Pam Desert CA 92255
760-200-0811
A proposal submitted to: ROBERT & NANCY ENGEL .
Mailing Address:53580 RAMIREZ LA QUINTA, CA
Job Address:SAME AS ABOVE
Phone:564-7264
Description of Work to Be Performed:
OBTAIN ALL REQUIRED CITY PERMITS.
REMOVE EXISTING ROOF AND DISPOSE.
NAIL ONE LAYER 40# TILE LINER.
INSTALL NEW ROOF JACKS AROUND PENETRATIONS (H.V.A.C.& PLUMBING)..
REPLACE ALL ROOF TO WALL SHEET METAL.
INSTALL LIGHT WEIGHT ROOF TILE (U.S TILE- VALLEJO) TO MANUFACTURES
SPECIFICATIONS.
CLEAN ROOF AND GROUND AREAS.
IF NOT ACCEPTED IN 30 DAYS THIS PROPOSAL IS NULL AND VOID
Notes: In Keeping with Industry standards: 1. This guarantee does not cover any damage to the interior or exte-
rior on which the roof is applied or damage to any contents therein. This guarantee does not cover damage to
roof due to any cause beyond our control, including, but not limited to: fire, lightning, windstorm, hEilstorm, an-
tefinas or other equipment, foot traffic on roof, structural fault or settlement, cracking or other failure of the roof
dei k, walls or foundation of the building on which the roof is applied. 2. Should it become necessar- for the roof-
ing contractor to remove and/or reinstall any antennas, cooling or heating appliances or other equipment, whether
or not an additional charge is made for such work, the customer understands that neither Roof Tile Specialty nor
the installer ass sponsibility for the performance of said equipment. 3. Roof Tile Specialro, does not
ssume any 0 sibility corrections of existing code violations or for the repair of any existing defects un -
le eci m estimate an proposal.
Total t: $7,075.00 Te s paid on completion unless otherwise specified in the contract. If not acceptance in
thirty d this proposal ' invalid. Extra $35.00 per sheet of plywood if needed.
Acceptance: ereby authorized to furnish all contents written in the contract to complete work mentioned
in the proposal contract for which Uwe agree to pay the amount mentioned, in said proposal, and according to
terms thereof, . (Initial). If a leakage, caused by defects in workmanship, occurs within FIVE years
from date of application, we will repair it free of charge.
Installation: it is understood that by the acceptance of this proposal you authorize Roof Tile Specialty to make the
installation; to issue work order with specifications shown herein and to pay our charge for such installation.
You agree to pay the amount the specified herein, which will cover the price of said materials and labor charge.
This estimate. is based on a complete job and any surplus material remains property of Roof Tile Specialty. Verbal
understanding and agreements with representatives'shall not be binding unless set forth herein. There shall be no
liabilities for delays in, or failure to complete, deliver or installation of aJI-9T any of the herein mentioned mer-
chandise, if due to fire, strikes, war, government regulations, or any cause beyond our contract. Any changes
made by you in specifications herein, necessitating additional materials or labor shall not be included or covered
by this proposal, but shall be provided for under separate and additional order from you. ( Initial).
Arbitration of disputes: Any controversy or claim arising out of or relating to this contract, or the breach thereof
shall be settled by arbitrator in accordance with the applicable.Construction Industry Arbitrator Rules of the
American Arbitration Association which are in effect at the time the demand for arbitration is filed. A judgement
upon the award rendered by the arbitrator(s) maybe entered in court. having jurisdiction thereof. Any arbitration
The
award shall be subject to correction and/or vacation for the reasons stated in the code of civil Procedure. ar-
bitration shall award reasonable attorneys fees and expenses to.the prevailing party. After being given due n tire,
should any party fail to appear at or participate in the arbitrator proceedings, the arbitrator shall male an aw
based upon the evidence presented by the party(ies) who do (does) appear and participate.- Notwithstanding Con -