9510-049 (RR)cA LICENSED CONTRACTOR DECLARATION
CM I hereby affirm that I am licensed under provisions of Chapter 9 (commencingwith
LU Section 7000) of Division 3 of the 919 and pro"fessionals Co�Je,3and-my
�
C) � License is In full force and effect.
ri W License # , Lic. Class P Date
nZ r `Date P® t QSSgnatureofContractor <: / • C' moo+
rn0r.
co H rn OWNER -BUILDER DECLARATION
J IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
Z() 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
N
O rn WORKER'S COMPENSATION DECLARATION
Q Q I hereby affirm under penalty of perjury one of the following declarations:
o g Z ( ) I have and will maintain a certificate of consent to self -insure for workers,'.
HO compens tion, as provided for by Section 3700 of the Labor Code, for the
X W IJ_ perform ce of the work for which this permit is issued.
p J J ( )VA have and will maintain workers' compensation insurance, as required by
m U U Section 3700 pf the � abor Code, for the performance of the work for which this
permit is issAV WIrw p CUM' p y
a � Q p y orkers' com ensation insurance ci�rne &- olic no. are:
rn F- Carrier Policy No.
I Z (This section need not be completed if the permit valuation is for $100.00 or less).
co o() 1 certify that in the performance of the work for which this permit is issued,
(3 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: 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 Applicatiornis 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 a rite represen Dves of
Jbis City to enter upon the
•
above-mentioned property for In n pu�ose .
k �Slgnature (Owner/Agent) Date la -/10 "i p
=a'v 31i.fl.Jl+I!
ALC. jg��6,� 5
xg: J `It*DING PERMIT !"RMIT.
DATE
VALUATION LOT
TRACT R
1411 Alec:-RE.XAIU13k'�S
JOB SITE ADDRESS
APN
OWNER
EVANIM
CONTRACTOR
$3124 RUE PARA.Y
53-71.1AVE. BE'"ItUDAS
11 DIO CA 92201
L.AQUINTA E,A, 92253
6I93M186 CBL# 31.9
GEINIFRAI, BUILDING
DESIGNERIENGINEER
USE OF PERMIT
RmOOF FEE DESCRIPTION -100,601.3
FEES '
;SSA 3AI'W D Can OF a:oms'r.Rwr ON
SUMMARY
SLtt3-iOTAt. COINTSTRUCTIO 11'IND PLAN CRECK
$30.00
LESS PIPE -RAID FEES
SOM
TOTAL '1'ER14 IT i+k,EN 1")U.11DNOW
$30.00
T0Ti,V*, 'PRG. ECT PrR&UT F EMS
30.00
X
ll
RECEIPT
DATE
BY
DAT�Fl
INSPECTOR
L, k
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I 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
/.0h gzgL
Final
Final
POOLS - SPAS
BLOCKWALL APPROV S
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)
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)
TO
nPfl
PROPOSAL and CONTRACT
Dale _ ,19
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propose to furnish all materials and perform all labor nyfessary to
mplete the following:
er// G'✓ e) ti
V
-i r,- c
All of the above worktobe completed in a substantial and wo/rkma
sum of / n 0--e G / n ev SAw� ON f !V u -s ,-c1AA-,0
Progress payments to be made
manner according to standard practices for the
ao
Dollars ti
as the work progresses
to the value of per cent (_%) of all work completed. The entire
amount of contract to be paid within
days after completion.
Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed
upon written orders for same, and will become an. extra charge over the sum mentioned in this contract. All agreements must
be made in writing.
Name and Registration Number of any salesperson who
solicited or negotiated this contract:
Name No.
Contractors are required by law to be licensed
and regulated by the Contractor's State License
Board. Any questions concerning a contractor may
be referred to the registrar of the board whose
address is:
Contractor's State License Board,
31:12 Bradshaw Rd.
Sacramento, California 95826
ACCEPTANCE
You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the
Respectfully submitted,
By C. V. ROOFING
P. 0. BOX 1256, INDIO, CA. 92202
619-398-515Aess .
Telephone 352007
Contractor's State License No.
You, the buyer, may -cancel this transaction at
any time prior to midnight of the third business day
after the date of this transaction.
Above proposal, for which agree to pay the amount mentioned in said proposal,
and according to the terms thereof.
ACCEPTED
NOTICE TO OWNER
. Under the Mechanics' Lien Law, any contractor,
subcontractor, laborer, materialman or other person who
helps to improve your property and is not paid for his labor,
services or material, has a right to enforce his claim
against your property.
Under the law, you may protect yourself against such
claims by filing, before commencing such work of
improvement, an original contract for the work of improve-
AIGNER FORM NO. 55-037CAL
Date . 19
ment or a modification thereof, in the office of the county
recorder of the county where the property is situated and
requiring that a contractor's payment bond be recorded in
such office. Said bond shall be in an amount not less than
fifty percent (50,%) of the contract price and shall, in
addition to any conditions for the performance of the
contract, be conditioned for the payment in full of the
claims of all persons furnishing labor, services, equipment
or materials for the`work described in said contract.
•RINT[O IN VSA