0403-289 (RR)U)
F-
N U)
W
O0L
W
oZr�
CC) O. o
_JVLu W (0
to
Z
M
LO
N
ON
U °)
EL Q
`,F -O
0 J J
mVU
O
li M
It Z_
CIS 5/-y
r- V
Q
J
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
336547 C39 B 07/3112(
Date ' rot -C -t Signature of Contractor
OWNER -BUILDER DECLARATION
r
I hereby affirm under penalty of perjury thatf'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.
(,, i 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 ST:A6TZ? MM Policy No. 2£iS-iin-0019 5-0E
(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 provisiorns of Section 3700 of the Labor
Code,:l-shall ort��i�,witih comply with,etthose pro fu sions.
Date'` �i1 Applicant-
Warning:
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to cri inal 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 in 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.
f , ..� "*
Signature (Owner/Agent) L�1 A t/'``Date �"' _12 -Cl
BUILDING PERMIT PERMIT# /
V
DATE VALUATION LOT 0403-288. TRACT
- 03/18121K $.317519.00
JOB SITE
APN
ADDRESS 49-775 CO_4C11E-L1,4.DMVF
- -
OWNER
CONTRACTOR /DESSIIGNEN INFER
TED PVpfU,
L YMArt & vVAS ROCTNO
49-715 COACRRUA.I?i.2.i E
68760:3► MORTDME
JA QMVrA CA 9225:4
CATH K)I l (11ITY CA 92234-
-(760)326.66116 C B1.4 106
USE OF PERMIT
RF,,fit7OFVnTi's CLASS "A" MATERIALS. 114V'ES'CF:I;AnON FEE ASSMSED
4',�:R 1A97 it aG 304,51031i�Jiil� ) 0f�t� `fit i3'OiJ'C A P3%IdA.�IT
V./ GUATiO-H 3,750,00 LS
Iz;S"MA7'.L+D COST 0-F CONSMB.7'M0.1•1'
3,750.00
YERMANYMORMILWARY
REROOF ME 301 -000-418-000 $30.00
I11V N a`I''IQKf(GV Irft 101-000-423-000 $30.00
MAR 18 2004
CRY OF LA QU A
Fcaal�,rac�!?3?E�
SUB-TaLkT_ CON ErM:I:iCTIM AND PLAN MIECK
$60.00
LESS PPE, PAM ITES
$0,00
'I'tA'I'A,1'.. PFARAIi'Y FRES DUE NOW
M.00
V
RECEIPT
DATE
BY
DAT NAL
INSPECT
y' — V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel - —
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation.
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FRf_1Me : TO FAX NO. : 7605644926 Jan. 29 2004 04:46PM P1
(� w'60
AL MILLER A.N.D. SONS ROOFING CO., INC.
"BEI ER ROOFS FOR >l;l✓' I ER LIVINGo
68-760 SUMMIT DRIV$, CATHEDRAL CITY, CA 922,34
PI 1. (760) 346-1214 FAX, (760) 321-7097
LIC!~ NsE # 336s47
PROPOSAL AND CONTRACT
Owner: Ted Operball lirojcct: Rr/Roof
Address: P.O. lion 955 Address; 49-775 Coachella
City: La Quinta, Ca. 92253 City; Lit Quinta
Phono, --564-4926 "
WL' NtOl"GS)i111) volzx)ia11 '1'l il3 I'V 1A)WING MA=-r\1A1,S AEvn PI 1tT'URM ALL LAt30R To Rt]OF TlIC: Al30Vli OC I'ION,
Tilc Deeks: Roofer to -Rift and moxg-cA'fig, 4fle from deck. Roofer is then cleat-1p4A►repare current
material for new fell. Roarer to then Nail iaYellt ASTM base over existing matutiul, then rcirt,rtlal! (>
ori na!"lilc.per mzt ufactyres recommendation. Roofer to include new sexondary tl�rlt�inK9, rail :tint �
Terms- Net Cash On Cumlep bion
A'CxENTION
-..arc r• ..• Section 7018 of the Conlrue(ors License w pruvides thct staA4tg July 1, 1966, evct7onc 1i nscd by_,tl:c Goutraetor s,l.iec�sealo�rd shalt o:.:: :�::,;
give a copy of the rollowing notice to Law the peyor prior to receiving from the olvitu of.thCpt> rrly.or.his "ugcnl"rny. paysnent.for ~Voll, whlub s _ ..
cnntrnctor's license is required
NOTICE
"Under ille filo ttftoics' LII Low, itay subs untractur, luboror, supplicror other persar. who holes to iniprova your pR)Nrly but i4 nogald ibt-
tiscrr work or supplies, has a right to enforce a claim aGtciim your property. This marts Ihat. tiftc:r o Co -id hr-.Qin€. your property could In; sold �
by a court oMcer for tido pmeccds of die .tale used to satisry the indeblecbicss. This can bnppen ever, 1F you have paid your own contrtctur ill
full, irttic xabcenimtor, laborer, nr supplier remained Lmroid.1
N_
1
All Millet & Sons Koof+og Co., Aim AeMs to fumistt its regular roam 6UAItAN1T r, fol 2 Ywitis afl= completicnt or its said work, Elnld "
guaiwitcc to cove dcfbcts it ninterdai yid warkmanxh(p oily and not to mwd to damage to m r.q caused by the eleulent'i, other u4usu;il
Acts of Gad and shill not corer any iiaWity for damcigo io 4itativry Gxtumst de orations, wulis, contents of building or other ixsrls of struolun:
not to da,ttigc of faully construction. It is algin understood and armed that (he above gearnatcC 91101 he 110dC and IC osis only whet unit ii"
pay inot( is made as agraxl in this contiact. Al Miller & Son; is not mspondible for I14 antennas.
We are A:ily cnvercd by Wurkawki's compelm'ion petit public llnbli ty insurance. Carriers' stairiLs cb-W polity ti=bcts Arc avadabic on reoluest.
Any al(mlioru or deviations :born the above spccificadons involviog, extra cost of motorial or labor wilt -only be cxceutai upon wrkim urdcrs
for scuno, and ,rill become tea extra clurze over sunt mentioned in this proposal. All egnemerts magi be naade in wriling.'I his offer is velid fur
ono week frold the dule of C>li»i;itt Eau] iS b,ued On free ucecsS to building for din:cl loadino froti our truck.
Priers arc based on curet it cost ormatrrial yid labor, increases nr decreases w4I tie refloGcd tri time gPsl lnE ofeortrocl Al Millur c- Suns
Is not responsible for any dnum3o to sidewalks, ourbs or drivcwtlys. If Uiere is any conflict between this propose end any adher euatruct ar
Ined icallon relating to the allow rercrcnced project the tains of ihi_c proposal sfrtll Im;viil.
ltespectAlliy submitted,
Aceeptnl: � ., AL MILLER & SONS ROOriNG., INC.
By: Matthew Milkr, Fmimator
Do to: ZY'e y/ Nte: 1 -IS -04
to 'd 99999922£ 'ON Xii. ONIAOON SNOS I 8.-i111U ld U-1 t5:9.n nll.l bnn?.-R7-mwr
(�oa
CITY OF LA QUINTA
cFM P O C I,
I DING & SAFETY DEPARTMENT
c z t 777-7012 i
N 3Id qSPECTION REQUEST LINE
__ 5 v 777-7153
Contr ct �L-TMr R & SONS ROOFING
PermN l ' 3J89
POST b N CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-775 COACHELLA DRIVE
RE -ROOF WITH CLASS "A" MATERIALS.
INVESTIGATION FEE ASSESSED PER 1997 UAC
304.5 FOR WORK BEGUN WITHOUT A PERMIT
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING/ WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
s Rt}L / PRE -ROOF C
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST _
SEPTIC ABANDONMENT ^
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4