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LICENSED CONTRACTOR DECLARATION � BUILDING PERMIT
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 DATE VALUATION LOT
Professionals Code, and my License is in full force and effect. 1211197�
License # Lic. Class E p. Date
00.00
JOB SITE
ADDRESS .
/ ' 16547 9 7/3 '78-043 CM LE CADIZ
~,Date, Signature of Contractor ✓ �- OWNER
OWNER -BUILDER DECLARATION ,/**—
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: a
( ) 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.
( ) 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.
S'I'N133 WND • 14N432-97
(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 gree that if I should become
subject to the workers' compensation provisio s of Section 700 of -the Labor
Code, I, shall forthwith comply with Pose rovlsio,s:
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 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 inspec ion purposes. /
Signature '(Owner%Agent) Date
TUP.PIN CONS°TRi3MON CO.
54936 SHOA.1a CREEK'
LA QUINTA CA 922.53
USE OF PERMIT
a
RE R.00F 11 RCHANTICAL AREA Suis Sr
PERMIT # CO/NNTTROL #
,i /#
']2-003 TRACT V Z V 8
APN
CONTRACTOR / DESIGNER / ENGINEER
Al, MILLER & SONS k0rifINO
68760 SUMM.ff DRIVE
CATHEDRAL, CITY CA 92234
(7�fl 325. 1e CBL# 106
REROO ° 900.00 LS
PERMIT
per- y p� C�*7� �{ � L8`t7MlATLD COST or,CON. '.�t�fC [ON, a. 00.00
REROOF Ft: E 1101 -OW -418-000 $30.W
RECEIPT
DATE I BY I I DATE FINALED J INSPECTOR
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Sl':�-tt7l'AL Ci�N�'!'iZU�"Ci�I� t1N'l� P.Gt1�! C��1C�Z
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LESS PR&PAW PEES
$0.00
TOTAL PED7:N11i FEES DUE NOW
S30100.
DATE I BY I I DATE FINALED J INSPECTOR
Ind
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 I I I
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:
ke__ Igaz(�
I
AL MILLER & SONS ROOFING CO., INC.
_ +> "BETTER ROOFS FOR BETTEW MNG"
68-760 SUMMIT DRIVE, CATHEDRAL CITY, CA 92234
(619) 3461214 and 32&6616
STATE LICENSE -336547
PROPOSAL AND FREE ESTIMATE
Location of Job La Quints, Calif.
CONTRACTOR OWNER
Turpin Construction, Fax: 777-7613 Cunards Restaurant
54-936 Shoal Crook .
La Qdinta, Calif. 92253 (777-7611) 28-045 Calle Cadiz
We propose to furnish the following materials and perform all labor necessary to complete the roof at the above location.
Roofing Contractor will remove existing foam on flat roof section, any plywood
needing to be replaced will be charged at $32.00 per 4 x 8 shoot.
Roofer will scope tack as necessary to accomplish positive water flow from roof
deck. Rooter will remove and replace wood shake necessary to complete flat roof
section. CONTRACT PRICE: $3,800.00
All of the above work to be completed in a substantial and workmanlike manner according to standard practices for the
sum of $ Dollars ($-It--fgee Above t
TERMS: Net Cash on Completion.
ATTENTION
Section 7016 of the Contractors License Law (B & P Code, Div. 3, Chapter 9) provides that starting July 1, 1966, everyone licensed by the Contractor's
License Board shall give a copy of the following notice to the payor prior to receiving from the owner of the property or his agent any payment for work
which a contractor's license is required.
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1181 at seq.), any contractor, subcontractor, taborer, supplier or other person
who helps to improve your property but is not paid for his work or supplies,'has a right to enforce a claim against your property. This means that, after a
court hearing, you property could be sold by a court officer for the proceeds of the sale used to satisfy the indebtedness. This can happen even If you have
paid your own contractor in full, If the subcontractor, laborer, or supplier remains unp4Vb (2 )
At Miller & "Sons Roofing Co., Inc. agrees to furnish its regular form of Guarantee for years after completion of Its work, said guarantee to Cover
defects in material and workmanship only and not to extend to damage to roofing caused by the elements, other unusual causes or Acts of God and shall
not cover any liability for damage to Interior fixtures, decorations, walls, contents of building or other parts of structure not to damages arising from faulty
construction. It Is also understood and agreed that the above guarantee shall be made and remain only when and If payment is made as agreed In this
contract. AI Miller & Sons Roofing Co., IncAs not responsible for TV antennas.
We are fully covered by workmen's compensation and public liability insurance. Carriers'.names and policy numbers available on request.
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 sum mentioned in this proposal. All agreements must be made in writing. This offer Is valid for one week from the date of
astimateand is based on freeaccess to building for direct loading from our truck.
Prices are based on current cost of material and labor. Increases or decreases will be reflected at time of signing of contract.
Not responsible for any damage to sidewalks, curbs or driveways.
Respectfully submitted,
ESTIMATE AL MILLER & SONS ROOFING CO., INC.
o
Accepted: Sy'jawara KCA10nay, nt fat nx
October 10, ' 10"1 .
Date: ,19 Date: