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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
Date Signature of Contractor ✓� ^����'�
OWNER -BUILDER DECLARATION
I hereby affirm under, perially 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).
( ) 1, 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 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 37 , of the Labor
Code, I shall forthwith comply with thos prouigiomsf
Date: ,1— -'Lial Applicant
_..Warn,.ing:,,f ailure,to:,secure.Workersti,Compensation doverage is unlawful and
shallsubject'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 thisapplication 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 insp ctti n pur ses.
Signature (Owner/Agents.-1-1/11 ✓ Dates— 5
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0_,tO& TRACT
JOB SITE $ APN
ADDRESS "
54w-635 AVEMDA RNUM TRW -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
t;; �i.WRY'.ANDEMOM-
PAM -10
X4.63 5 .a3VMIl ADE'RY1C1 D.1 0
3,462 LA 4.•AWARA4.WAY
I.A.QI.TktiUA C.A 9 .?113
PSA W:RS 103 CA 92262
y
(760)416-5877 MR 4293
USE OF PERMIT
C 141T.k'Li�ISIT;��Ti�
iE.F,PaF.OIDY V X'C9LYU.R:E'X'HANX+: YO.a1*M OVER MISTINQ BUR
Rt3e ' 4,448.00 LS
:'SID IM) COST (3:I,+' CUP YIN UC' 1ON
4;4480)
PERWOrPM, SUMMARY
:F',�.00Fs F F, 101-M-438-000
1:. r'OMSTRiDC I;kOfii• !j,'C`I:O PI,:AM CRE+.CS
$30.00
Dli11 7.: IMS PaI. E -PAM k!?TM
$0,00
JUN 2 5 2001
CITY OF LA OUINTA `
Y
DATE INALED
INSPECTO
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
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 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
Plumbin! Top Out
Equipment Enclosure
Showerpans
O.K for Finish Plaster
Sewer lateral
Pool Cover
Sewe�Connection
Encapsulation
Gas Piping s.
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:
TERN PACIFIC
Roofing Corporation
Since 1949 Lic. 4235717
Mav 22. 2001
Ginny Anderson
54-635 Ave. Bermudas
La Quinta, CA 92253
RE: Re -roofing project; 54-635 Ave. Bermudas, La Quinta, CA 92253
Application of a Polyurethane Foam and Acrylic Coating Roofing System.
Dear Mrs. Anderson:
Thank you for the opportunity to submit a proposal for the re -roofing at the above referenced property. We
are pleased to submit our recommendations and proposal for the installation of a polyurethane roof
system. The recommended scope of work and associated costs are as follows:
GENERAL
Unless expressly stated to the contrary, the contractor shall be responsible for performing the following
acts.
DESCRIPTION
A. The general conditions of this standard construction contract shall form a part of these
specifications with the same force and effort as though repeated herein.
B. The contractor shall furnish all labor, materials, equipment, permits, contractor's licenses,
insurance certifications, etc., to perform all operations required and specified The contractor
shall provide labor and material customarily included in work of the same nature to give a
quality, complete job. ..
C. If unexpected conditions are encountered during the work, and the conditions adversely affect the
cost or progress of the work, the contractor will notify the owner immediately, and the owner will y°
negotiate a change -order to resolve the unexpected condition.
D. The Contractor shall occupy, use, and permit others to use the premises only for the purpose of
completing the work to be performed under this contract with the Owner. The Contractor shall
not authorize or permit any other person to use said premises for any purpose whatsoever.
Western Pacific is to be given all reasonable set-up and staging areas.
E. Contractor's scope of work shall not include the identification, detection, abatement,
encapsulation or removal of asbestos or similar hazardous substances. If Contractor encounters
any such products or materials in the course of performing its work, or if such hazardous
materials are encountered by any other firm performing work at the jobsite and contractor
determines that such materials present a hazard to its employees, contractor shall have the right
to discontinue its work and remove its employees from the jobsite until such products or
materials, and any hazards connected therewith, are located and abated, encapsulated or
3462 La Campana Way • Palm Springs, CA 92262 - (760) 416-5877 • Fax (760) 320-8912
www.westpacroof.com - E-mail: wprcps@westpacroof.com