9808-018 (RR)LICENSED CONTRACTOR DECLARATION .
I Hereby _affirm under penalty of perjury that I am licensed under provisions of
FF— Chapter 9 (cornmencing�with Section 7000) of Division 3 of the Business and
C14W ra Profe;,sionals Code, and my License is in full force and effect.
M License #,,' Lic. Class Exp. Date
Ci .i., 98 C39 3/31/40
LU ` t
ZYI
O ;Date Signature of Contractor V s
J UCID 'it
OWNER -BUILDER DECLARATION ✓ ��
WWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
( License Law for the following reason:
Z ( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
co () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
o�
d Q WORKER'S COMPENSATION DECLARATION
o C1 I hereby affirm under penalty of perjury one of the following declarations:
0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q U () I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
dLO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob Q S`T'!�. E FUND t)i 1513247
��! J (This section need not be completed if the permit valuation is for $100.00 or less).
C, ( ) 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
tA, workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 37Ad of the Labor
Code, I shall forthwith comply with se provisions. f
Date: ?, Applicant
K �.
Warning: Failure to secure Workers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a 'permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is note commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize .representatives ofAhis City to enter upon
the above-mentioned property fori spection purposes
.Signature (Owner/Agent) &; ,,. c'" a w�- Date Af,
BUILDING PERMIT PERMIT# °°NTR°`#
9f�413�-1P�?► . �`
DATE 81414,$ VALUATION '�3,800.N) LOT TRACT
;. 7372
JOB SITEJ
ADDRESS 49.408 COACHELLA DRIV '. :
APN . teai1-337s-00
OWNER CONTRACTOR / DESIGNER // ENFGtINEENGINEER1
'SE�'Iy 4' L r�:f'i :T:n' JR.. =13F�I AR 1j�'�''Q1�Z ii.00." #.NO
IND10, CA 9 201
(100)34._:%&4 CHL# 1157
P
g
USE OF PERMIT q; g
t FN RAL, 131.1i.1,DfNG
RWOVE ANI) it1MPLACE 13:/11.3-L!`1', ROOP,
AUG 04 1999
CITY OF
LA QUANTA
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PKilR;E'A.5'li 1 u.c swWwAjF v
RJM00 IFE-U 1.01-000-418-000 S 3fs.4
S[ I =1 �TFii,�'C7h5fiiZrtt°11C,I� AND PLAN CHECK
530.00
LESS PRF -PAID FEES
SO -00
RECEIPT
DATE
BY
DLE�
J
INSPECT -
e�l1
, INSPECTION kC_`0RD
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
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: Q
11
RUBEN M. VASQUEZ ROOFING
45-020 ELMISTREET 1619) 347-5683
INDIO. CA 92201
UC. NO. 456498
Date -2- t9 90 TO CAL TtCH LS'UIL0C S
49-008 COACHELLA "'9I:. LA 0111I;:1T„ CA. (hereinafter "Owner"). Telephone no.I )
J,ySO,!EZ OOFI;JG
(hereinafter "Contractor-)
propose(s) to furnish all materials and perform all labor necessary to complete the following: (Insert a. description of the work to be done and a description of the materials to
be used and the equipment to be used or installed, and state the address of the job she.)
1. PE, fOVE ULD 1;OOF COi1PLETLELY IF U IABLE TO R;E`MU)VE 1;OTTOM ROOF A LAYER OF 1121
SOU; 03OARD ,JILL E .JAILED ON TO 7NSU2E A S?•fOMf SURFACE.
2. vE?OOF 11SI.NG THE FOLLOiI"I Ji %!ATERIALS:
O?IE PLY OF 28%1 GLASS SASE NAILED ONWITH 1" SQUZRE CAP !L;ILS
O!1E PLY OF 11 n GLASS PLY MOPPED ON WITH 2511 OF HOT ASPHALT
O`.iE PLY OF '730 MODIFIED CAP !OPPED O.V !'IIT' 250 HOT ASPHALT
INSTALL NEV ROOF FLASHINGS AN9 GRAVEL STOP THROUGHOUT
3. LIFT 'MOF TILLE A., D TIE HIEN ROOF TO PITCH "OOF
4. CLEAN ALL ROOF Dr3PIS UPON COMPLETION AND RE'AOVE FROM P':E:f7SES
5. GNA"2ANTEc .l?OOF LASOR FO1? FIVE YEARS FROM DATE OF COMPL>=TION AND PROVIDE
KITH QRITTEN MANUFACTURERS NARRANTY.
All of the above work is to be completed in a substantial and workmanlike manner according to standard practices for the sum of _
TH'RIEt THOUSAND EIGHT HUNDRED Dollars Is
Progress payments shall be made as follows: PAY,As'Erk1T IN FULL UPOt! CO'M'PLETION
3800.00
to the value of O:t;E H1;,N9RED per ant ( 100 %) of all work completed.
The remaining balance o1 the contract is to be paid >Xi X UPON 're:a( ACompletion.
This proposal is valid until XXXXXXXXXXXXX;<, and if accepted on or before that date, work will commence approximately on
artd will be substantially completed approximately on XXXXXXXXXXXXXXXX;<X XXX XXJ:, subject to delays caused by acts of God, stormy weather, uncontrollable
tabor trouble, or unforeseen contingencies.
Any alteration or deviation from the above specifications, including but not limited to any such alteration or deviation involving additional material and/or labor costs, will be
executed only upon a written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to
the contract price of this contract.
If any payment is not made when due. Contractor may suspend work on the job until such time as'all payments due have been made. A failure to make payment lot a period
in excess of days from the due date shall be deemed a material breach of this contract.
Respectfully submitted.
Name and Registration No. of any Salesperson who solicited or negotiated this
contraci:
Name
No.
1 UBF_N M. VASONEZ
R" 01
45-020 ELf ST..
SOW Address
I.k970, CA. 92201 347-5633 ( )
WY $we zo Talepto No
455498 —
ACCEPTANCE
coedrxror's Stu taonss No
You are hereby authorized to furnish all materials and labor required to complete the work mentioned in this Proposal, for which I/we
agree to pay the contract price mentioned in this Proposal, and according to the terms thereof. I/we have read and agree to the provisions
contained herein, and in any attachments hereto, which are made a part hereof and are described as
City
owners Name
Street Address
State
zip
9us,neSs Address ( ) I
Business phone No
ACCEPTED:
townrlSignature I (nater
Contractors are required by law to be licensed and regulated by
the Contractors' State Ucense Board. Any questions concerning
a contractor may be referred to the Registrar, Contractors' State
Ucense Board, P.O. Box 26000, Sacramento, CA 95826