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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch.Apter 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
73n4".0 Cay /11044
Date ' �f /A of Contractor �� .�� t Z�e
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 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:
Cartier Policy No.
.T,11 is l't1; ft) 416 91) MN T (XMI.057
(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
Xate: • 1/!%rl�1 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.
r
VSignature (Owner/Agent) ;,�� �� / - Date—/,,
BUILDING PERMIT PERMIT#
wwla-09z
DATE 2171" VALUATION Si�►.(II�iIQi1 LOT TRACT
JOB SITE
ADDRESS !-.1�.31�`��l�l�i]tI# 11�iltAlLiD.�.�]I
APN 773-1"OZI
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RICHARD L 1411.1.
1lRSI11ANE. FDA %I C9NS1 I1.I1r.'L & sI'kN It
110 WX 1935
1110 BOX 08 .
CARLSBAD CA 92018
'11k)LISAND PAUNIS CA 1i2270
(7001346-9910 (111L`i
USE OF PERMIT
uliNERAL 11011.01Nu
RL -ROOF - Rlt kiuVE L.KC, f i Nti RU<.Xti do LaRA��EL. AN►,L t NFi* i Rl t IIL\vl's
I,UAM W1 AC'KYLK' Pt-A.;1t1.ME Ik' c'( )AXI N % i (IC:B() tt4o.Wi
121T�"x•F ti.Clily" tlii ;,:,
ESTIMATED CONT OF CONS I IMCi OIN
6.000.00
PERNIff 1V IKE SSIJAI 4,r RV
RFACK)F FEE 101-(i(1f?-•118-000 3w t}�►
�+F►�At, CONrr17RUMONANOV1 ANi114117(1t
culM
LUSS PRE f AID ITES
so UO
19
A,� I't�l +�i, PERMIT 1H lel ti DUE NOW
8300)
RECEIPT ✓
DATE
BY
DA
INSPECTOR
INSPECTION RECORD
OPERATION
a
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 AP ROVALS
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
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:
ICBG Evaluation Service, Inc.
,P
W UN FOR °
0 BUILDING m
000E 5360 WORKMAN MILL ROAD • WHITTIER, CALIFORNIA 90601-2299
1005 A subsidiary corporation of the International Conference of Building Officials
EVALUATION REPORT ER -4630
Copyright 0 1996 ICBG Evaluati n Service, Inc. Reissued August 1, 1996
Filing Category: ROOF COVERING AND ROOF DECK CONSTRUCTION—Roof Covering (202)
PERMAX 108 ROOFING SYSTEMS
RESIN TECHNOLOGY COMPANY
2270 CASTLE HARBOR PLACE
ONTARIO, CALIFORNIA 91761
I. Subject: Permax 108 Roofing Systems.
II. Description: A. General: The Resin Technology Corporation's Permax
108 Roofing Systems consist of spray -applied foam plastic and elastomeric
coating. The foams are classified as RT -2030 and RT -2031 polyurethane foams.
The coating systems are labeled as Permax 108 grey base coat and Permax 108
white top coat. Foam thickness, density, coating information and roof -covering
classification for the various systems are in Tables 1 and 2. Typical roof penetra-
tion and flashing details are in Figure 1.
B. Deck Preparation: Roof surfaces must be free of grease, oil, dirt, sediment
and moisture. All surfaces, not covered with foam, must be masked off or other-
wise protected from overspray. All parapets, crickets and valleys must be flashed
in accordance with the code. Where precast concrete planks are encountered,
all joints must be taped with minimum 2 -inch -wide roofing tape identified as
DT -100.
New plywood decks must be primed with a neoprene primer. New concrete
decks must be allowed to cure at least 21 days prior to application of foam. The
surface is then primed with a catalyzed urethane primer.
New metal decks are primed with atwo-component wash primer. Gaps in end
or sidelaps must be sealed with an approved sealant.
Where wood decks are permitted, the deck may be covered with avapor barri-
er in accordance with manufacturer's specifications and with the approval of the
building official.
C. Foam Plastic Application: The foam is spray applied to the prepared sub-
strate in minimum '/2 -inch -thick passes to thicknesses noted in Table 1. Wind
velocity cannot exceed 12 miles per hour during application. Application shall
not proceed if the ambient temperature is less than 40°F. or if the substrate tem-
perature is less than 50°F. The foam cannot be applied over wet substrates or
if rain or inclement weather is imminent. The foam is applied in a one-to-one ratio
with equipment capable of metering each component within plus or minus 2 per-
cent of the design ratio. If the foam application is terminated before the final thick-
ness is attained, additional foam may be applied within 24 hours, provided the
existing foam is primed with a catalyzed urethane primer and a minimum of
112 -inch foam is applied in a single pass. The foam must be free of bumps, pin
holes and ridges. Any of these irregularities must be eliminated.
D. Coating Application: The coating is applied in two coats of contrasting
color at a rate specified in Table 1. The coating cannot be applied if rain, fog or
inclement weather is imminent or if temperatures below freezing are anticipated
within 24 hours of coating application.
E. Existing Roots: The roofing system may be installed over existing roofs,
provided the substrate is as required for the system. The existing roof covering
may remain in place if permitted by the building official in accordance with provi-
sions set forth in Appendix Chapter 15 of the Uniform Building Code.The roofing
systems described in this report may be installed over built-up, composition, or
asphalt -single roof coverings recognized by the code and the roof classification
will be as noted in Table 1.
Prior to foaming, the surface must be prepared as noted below to assure ade-
quate adhesion. All loose rock, cementitious coatings, peeling paint, dirt and de-
bris must be removed by brooming, power vacuuming or wire brushing. Blisters
in the existing roofing larger than 6 inches in diameter must be removed from the
roof. Blisters in the existing roofing less than 6 inches in diameter are to be slit
and nailed with 1 -inch roofing nails.
Curled asphalt shingles must be either removed or nailed to the deck. All pro-
jections through the roof deck must be sealed with roof mastic. Particular care
is to be exercised to seal under all roof -mounted equipment with cold -process
asphaltic products and to prevent roof depressions when it is not feasible to
spray foam. The surface is then primed with a chlorinated rubber primer at a rate
of 200 square feet per gallon and allowed to cure a minimum of one hour prior
to foam application. Spray applications are subject to the same conditions as
listed in paragraph II -C. On flat surfaces, the foam may be built up to provide a
slope to assure adequate drainage provided the maximum thicknesses noted
in Table 1 are not exceeded. Where the existing roof covering is removed to the
substrate, the deck is prepared and the foam plastic is applied as set forth in
paragraphs II B and II C, respectively.
F. Identification: All material drums and containers are identified by the man-
ufacturer's name and address, product designation, the evaluation report num-
ber (ICBG ES ER -4630), shelf life, and an Underwriters Laboratories Inc. label
noted as (R-10185, BW -345).
III. Evidence Submitted: Reports of tests in accordance with U.B.C. Stand-
ards 8-1 and 15-2, Fire Test Standard for Insulated Roof Deck Construction (UL
1256) and Acceptance Criteria for Membrane Roof -covering Systems dated
July, 1992 (corrected April, 1994).
Findings
IV. Findings: That the Resin Technology Company Permax 108 Roofing
Systems described in this report comply with 1994 Uniform Building
Code'", subject to the following conditions:
1. All system components are prepared and applied by qualified per-
sonnel approved by Resin Technology Company.
2. The roof -covering system is applied in accordance with this report
and manufacturer's instructions.
3. Where moderate or heavy foot traffic occurs such as for mainte-
nance of equipment, the roof system must be adequately protected
to prevent rupture or wearing of surface.
4. Where plywood sheathing, installed in accordance with Section
2602.5.3 of the code, or noncombustible cementitious substrates
are provided, a thermal barrier is not required.
5. Installations addressed in this report are limited to areas with a
maximum basic wind speed of 60 mph, Exposure B, on roofs not ex-
ceeding 40 feet above grade.
6. Products are manufactured at Ontario, California, with follow-up
inspections by Underwriters Laboratories Inc. (NER-OA403).
lirulhnaliuu report.+• ori('/10 Evaluation Service, Inc., are issued .solely loprovide information to ClassA members of ICBG, utilizing the code upon which the report
isbased. lirahudiou report.+are not to be coahstrued asrepresenlinA acelhelicsornay oilierallributes not specifically addressed nor as an endorsement orreconmen-
doliun.iio• use of the subiect report.
This report is baser/ upon independent tests orother technical data .submilled by the applicant. The ICBG Evaluation Service, bac., technical staff has reviewed the
lest resollc and/or other data, but does not possess test facilities to make un independenl verification. There is no warranty by /CBO Evaluation Service, Inc., express
or implied. ace Ira any "Finding "or other matter in the report or aceta any product covered by the report. This disclaimer includes, but is not limited 1q, merchantability.
Page 1 of 3
w
Page 2 of 3
7. All system components are produced at the Resin Technology ries Inc. (NER-OA403).
Company facility, 2270 Castle Harbor Place, Ontario, California This report is subject to re-examination in one year.
91761, with quality control inspections by Underwriters Laborato-
TABLE 1- PERMAX-108 ROOF COVERING SYSTEMS'
ER -4630
Ilixccpl where noted, suhstrale must be of noncombustible cementetitious materials.'
2tiubsUatC may hC, minimum t/) -inch -thick plywood bonded with exterior glue, with all board edges supported by blocking, tongue -and -groove joints or other approved
lype of edgC. support.
i'I'hc coaling is surfaced with No. 11 roofing granules applied ata rale of 50 pounds per 100 square feet to yield a minimum 100 mils thickness.
1SubslratC may hc, ccisting Class A or Class B gravel surfaced or smooth surface BUR over combustible or noncombustible substrates.
'scams in plywood duck must be covered with minimum 12 -inch -wide 911 -pound mineral capsheel.
('N/A Not Applicahlc.
71 lighcr slopes may be used subject to Resin Technology Company's written concurrence.
`tiuhslratc may he 4-1)1y BUR assembly surfaced with a flood coat of roofing asphalt and 400 lbs./square of roofing gravel embedded in the asphalt, with all loose gravel
rcnuivcd.
TABLE 2—FOAM SPECIFICATIONS FOR STEEL DECK ROOFING SYSTEMS
COATING
PRODUCT
MAXIMUM FOAM
MINERAL
FOAM
DESIGNATION AND
THICKNESS
MINIMUM
FOAM
ITEM NO.
MANUFACTURER
DENSITY (pct)
Coating
Dry Film
QUANTITY
1
FOAM
THICKNESS
2
MAXIMUM ROOF
3 Gal./100 Ft?
Application Rate
Thickness
THICKNESS
MAXIMUM
FOAM PLASTIC TYPE
SLOPE
ROOF
SYSTEM NO.
Gal./100 Ft2
(Mils)
TOP SURFACING
Inches
inches
AND DENSITY (pct)
Qn./Horiz. Ft)
CLASSIFICATION
1
3
24
Not Required
N/At'
2
RT -2030
1
A
2.5-3.0
3
24
See Footnote 3
N/At'
2
RT -2030
1
A
2.5-3.0
32
3
24
See Footnote 3
4
4
RT -2030
5
B
3.0
414
3
24
See Footnote 3
2
2
RT -2030
57
A
2.5-3.0
5
3
24
See Footnote 3
N/Ar'
4
RT -2030
5
A
3.0
3
24
See Footnote 3
11/?
11/,
RT -2030
5
A
2.5
7
3
24
Not Required
1
4
RT -2031
3
A
2.5-3.0
�2
3
24
See Footnote 3
1 IL,
4
RT -2031
1
B
2.5-3.0
Is
3
24
See Footnote 3
1
4
RT -2031
4
A
2.5-3.0
Ilixccpl where noted, suhstrale must be of noncombustible cementetitious materials.'
2tiubsUatC may hC, minimum t/) -inch -thick plywood bonded with exterior glue, with all board edges supported by blocking, tongue -and -groove joints or other approved
lype of edgC. support.
i'I'hc coaling is surfaced with No. 11 roofing granules applied ata rale of 50 pounds per 100 square feet to yield a minimum 100 mils thickness.
1SubslratC may hc, ccisting Class A or Class B gravel surfaced or smooth surface BUR over combustible or noncombustible substrates.
'scams in plywood duck must be covered with minimum 12 -inch -wide 911 -pound mineral capsheel.
('N/A Not Applicahlc.
71 lighcr slopes may be used subject to Resin Technology Company's written concurrence.
`tiuhslratc may he 4-1)1y BUR assembly surfaced with a flood coat of roofing asphalt and 400 lbs./square of roofing gravel embedded in the asphalt, with all loose gravel
rcnuivcd.
TABLE 2—FOAM SPECIFICATIONS FOR STEEL DECK ROOFING SYSTEMS
PRODUCT
MAXIMUM FOAM
MINERAL
FOAM
DESIGNATION AND
THICKNESS
GRANULES
PERMAX-100 COATING
ITEM NO.
MANUFACTURER
DENSITY (pct)
(Inches)
REQUIRED
QUANTITY
1
Resin Technology
RT -2030 and
2
Optional
3 Gal./100 Ft?
Company
R'I'-2131
(2.5.3.11)
Page 3 of 3
FNWI COMING SnIEM
POLYUREIFFANE FOAM
17 FOAM FAPER
G.I. FOAM
/,-S10P
NE W OR EX61NG
ROOF DECK
(RASH & LEAF C
DISCARD DRAIN
CLAMP RING
FINISH
CORING 7
L NE W OR EXIST.
ROOF DECK
PRIME R OR VAPOR
REWDER (F REWD)
I FACE OF BLIKDNG
PRIMER OR VAPOR
RETARDER (IF REOD)
TAPER FOAM 10 DRAIN
OPENING AND EXTEND FNWi
COMING SYSTEM 10 INSIDE
BOTTOM OF DRAIN CASTING
\ POLYURETHANE
FOAM
ROOF DRAIN
CASTING
- DRAINPIPE
FIGURE.1
FACE OF PARAPET
EXTEND FINISH COATING
7 MIN. ABOVE FOAM
TFRMPIATION PONT
FNISTI CONING SYSTEM N
POLYURETHANE
FOAM
NEW QR EXISTING J
ROOF DECK
PRIMEROR VAPOR
REEARDER(F REOI))
EXIEPDFNLLiCOMNG
7 MN. ABOVE FOAM
IERMNMIONPOINI n
PRIMEnonvAPon l�
REfAROFR (F fKO'0)
POLYURETHANE
FOAM
FNISFI COMW G IE.-\
112 -
MIN. R'MN.
VENT OR
PIPE
NEW OR FXISING
ROOF DECK
ER -4630
PROPOSAL and CONTRACT
RESIDENTIAL COMMERCIAL 0 MOBILE HOME C,
SPECIFICATIONS . 9; UIN DERSTANDINCS
1. Type of ioof(s): Hip0i Ca000 flat O' MetaIC3 String I les 0 . Sloped 0
2 Awnings included; TileC) 9041 Fell C]
3. Gar.ige included Yes j[K - No 0 Shed Yes 0 Nom
4. Carport included Yes 0 No EX Patio YesO NN3
S. Existing covering is TAR AND CRAVFL
6. Vacuum Roof YeX A3 No 0 Large Rock Yes)[1 No C3
7. Power Wash Yes 0 No XX Dump Truck Yeses No Q
8. Desert cooler removed and replaced Yes Nom PlalformC)
9. AC unit lifted and replaced Yes 0 No 13)r—inules Yes Cl Nom
10. AC duct urethaned and coated YesM<Noo Printer YeM3 No Cl
It. Color of coating Whi.W93. Other 0
12'. Application of coalinj I Cj 2 Q.V Ef ' Sheeling'4`?x g7:77F
13. Install unpainted metal edge, No. to. 4 ffl) Flashing No. Ft. 4'
14. Appearance of the finished roof surface will be pebbly and somewhat uneven.
Final roof surface will be affected by the texture of the existing roof surface.
IS- Foam will be tapered from a minimum inch thickness to a
thickness of approximately three quarter inch plus or minus at all
roof edges. Existing gravel guard will not be removed unless customer
wishes to pay the cost and replacement of new gravel guard.
0 Not Applicable.. Repairs & Coaling Only.,
16. Onlyjuose gravel, (lust, and dirt will be swept off. Secure gravel will remain
on the roof. Gravel will be remover] from premises unless customer wants it..
17: Completion of roof ,1f)Ilii6tion'W' iff beaffccted by i4e.1ther coiiellliij
includingpin,wind all(] fit.'
18. Urvillane- Foam Consulting & when
cannot guarantee removal of all
wl let d (Ponding Water)
water standing oil flat awls ell collip .
0
19. Definition of Ian ding water as per industry standards: A pool of water at
least 1/2" deep that remains in an area no less than 100 square feet
24 hours or more after a ram.
20. Roof rnuSl conform to 1994 Uniform Building Code concerning adequate
drainage of flat roof areas.
URETHANE FOAM SPECIALISTS
Wrelharie _7oam
Consulting & Services
27-555 RIO DEL SOL, P. O. BOX 638
THOUSAND PALMS, CA 92276
760-345-0622 - 760-346-9840
C&STATk -LIC...C-39 0,736420 -
Customer's
Name MRS HILL
Address ress 51 383 BERMUDAS
dress
lNearest Cross Street
Home.0.": Bus.
Code
23 dDale 1 /8/ . 99 I '�'; ri,!; 111 2483
100% 57YEAR GUARANTEE
If leakage, caused by defects in material a /or workmanship, occurs, within
rive years from date of application, we free of charge. Any other
work done by other contractors will voitl warranty.
System N
SPECIAL INSTRUCTIONS: ICBO REPORT 114630 OR ER -5289 PUL REPORT 4R1018S (This is 'class A over combustible decle,rallng)
Cily-Permit Reuuired--- - -YeTRF - _.NeQ-'-! - ... ...........
REMOVE ALL LARGE ROCK, SWEEP AND VACUUM ALL LOOSE GRAVEL AND DIRT FIROM.ROOF,
INC
.;j,Aj,f, NpW 3l, MFrrAl, FpGE. M0I)TFy 2 A(_, pUC,
_T OFFSETS APP1,Y NFQPRFI`Q1F PRTMFR
SPRAY 1" URETHANE FOAM TO ROOF AND RCT OR APPLY 2-APPLICAtIONS OF
ACRYLIC ELASTOMERIC COATING SYSTEM
NOTES: IN KEEPING WITH INDUSTRY STANDARDS
1. This guarantee does not cover any damage to the interior or exterior of the premises on which the roof is applied or damage to any contents
therein. This guarantee also does not cover damage to roof due to any cause beyond our control including, but not limited to, fire, lightning
windstorm, hailstorm, installation of antennas or other equipment, traffic on roof, structural fault or settlement, cracking or other failure of
the roof deck, walls or foundations of the building on which the roof is applied, or other persons roofs adjoining the structure.
2. Should it become necessary for the roofing contractor to remove and/or reinstall any aniennas_ coo I iifg or healing appliances or other
equipment, whether or not anaddilional charge is made for such work; - customer understands that n61tic, Urethane F.am Consulting
S.ervices, nor lhe installer assumes any responsibility for Ilie. performance of said equipment.
3. Urethane Foan) Consulting & Services does ow assume any responsibility for correction; of existing code violations or for the repair of any
existing defects unless specified in the estimate and proposal, including pre-existing foarn done by another contractor.
Total Costo TERMS: Paid upon completion unless Wrelhane ToaM
6000.
0:(E] otherwise specified in the contract. Consulfing & Services
The (late on which work will be subsiamially coinjileted is estimated to be 27-555 RIO DEL SOL, P. O. BOX 638
approximately 10 clays after commencement of work unlessa different estimated THOUSAND PALMS, CA 92276
completion (late is shown herein:
If not actcepted in -TO daYS-this pr-pposal. is- B ....
mutually agreed beginning (late: A 10hofIzell Representative
I i I
INSTALLAI ION: 11 i, I, le,slood tl,.,t by the --pi; ace of 1114 P,.p.,.,l y.. ...h.,it. Woh.ne I..,. & 1. -,Le lhe in.,,AhIi: (1) to 11,- ,
ilh —
16. ,.,d 42) to pay —, ch.,%� to, -h Y- IS- to ,.,y (o Urethane
F.— Consultinga the ,n ........ ... 11.i.ld
b_. bi, will
Price of Ad material and Ihe Installallon [barge.
ih6 1'.."d nn a 'Pl.., I.h and any --6M oAn, th, property of Lb,tha to.,., C--10.,,; & S,,vice,
v-1-1 u-11-1--14191 and a,.nl, wish shall, -.1 be binding ..'k— — forth h-;',
7h- shall be — Whih.y fur d,l,,, I,H In t—,pl—, &II—y of all nr ..y .f 11- I—i" ""Im.—I H d— I" fire, -N-
y
Any changes —de by y.o m lhe. herein, ocessWili,it; iddhio-I ro.,W, -1.,b., shall he Included --d by this p,.p.,.,I, b,,. 441 be
provided to, olnio, wp.11.11. ,nd ,ddill.11al y.p.
ACCEPTANCE''
Contractors are requiied by law to be licensed arid regulated , ;,��y auillbriZeil 10 fur' all ,,.a'
.9 You are hl. furnish let - iaKind-lab., required to
by the Contractor's State Liccns�c Board. "Any questi4,i curnpleit, the work mentioned in file above pi -010S.11, C"onlraCI fur %vhiCh I
concerning a Contractor may be referred 10 the registrar of the We agree to pay dic amount mentione(I in Siij proposal, and according to flu
board whose address is: terms thereof.
ACCEPTED:
Contractor's Stale . License Board ,
1020 N. Street A
Sacramento, California 95814 Omm•rs sign., ore
'POR YOUR PROTECTION"
CUSTI )AIlk - 1111-11 TE FILE - YELLOW t-VORK ()RI)EN - PINK WE ARE COVERED BY WORKER'S COMPENSATION,
AND WE HAVE GENERAL LIABILITY INSURANCE
(OVER)