0111-128 (RR)LICENSED CONTRACTOR DECLARATION
J,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
Z125717 C-39 T� ,o
rA3 W
`Date %"'J Signature of.Coritractor--,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 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 4,
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.
,N�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 STAIR FUND Policy No. 0457624-99
(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 3700 of the Labor
Code, I shall forthwith comply with those prgvlsio sr, A r"
g. ./
'Date: 1,,.- A-„ : 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 avid 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 ofAis 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 inspectio purpose.
Signature (Owner/Agent)''z•- "°'' ` °`off Date .0 - kJ/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01114:28 TRACT
S7,100M
JOB SITE
APN
ADDRESS 77-5W CALTA PMR.iF.R0
774-274-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JAMR.”MM%,NAIM
I%CH'tiIRG
77500 CAME Pf,2TRERO
34621 A PAHA WAY
:LA Q,,:Uf11Fl°ACA 12253
PA .13PR3NGS CA 9226.,2
(760!416-5877 UK*
r
USE OF PERMIT +
>is"rR.00F" POLY11", "W.N9140A di cua. ACRSt'.f IC COAT. CLASS M,Ps.7'E.[ IA1.S
ONLY
RER0 01? is
RERO F FEE 101-i1t3 _41 B-000 $10.00
x
NOV 1 6 2001
WYOFLA®UIINTA
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SUP,TOi6aNW.JL/N AWL) PLciCC
$30.00 0
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}ry
RECEIPT
DATE 11
BY
DATE FINALED
INSPECTOR
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
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:
0
F
WESTERN PACIFIC
Mu')
Since 1949
Roofing Corporation
Lic. #235717
March 23, 2001
Mr. Jim McDonald
41801 Corporate Way, Ste. #14,
Palm Desert, CA 92260
Subject: McDonald Rental Home, 77-500 Calle Potrero, La Quinta, CA
Application of a Polyurethane Foam and Acrylic Coating Roofing System.
Dear Mr. McDonald: V, - M
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 asthough 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 negotiate a change -order to resolve the
unexpected condition.
3462 La Campana Way - Palm Springs, CA 92262 (760) 416-5877 • Fax (760) 320-8912
www.westpacroofcom - E-mail: wprcps@westpacroof.com
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