0404-050 (RR)' 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 VALUATIONLOT
Professionals Code, and my License is in full force and effect. $15,$06},(30
License # Lic. Class Exp. Date
47'7550"/ B C39 � OWI /2(
Date `'{Signature of Contractor -
OWNER -BUILDER DECLsARATION
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 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 STATE FUND . Policy No. lfA2499.02
(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 Sectionr3700;.of the Labor
Code, I shall forthwith comply with those provisions -° e'°~
Date: 4•2 V'- "`I Applicant—
Warning:
pplicant 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
any permit issued as a result of this applicaton agrees to, & shall, indem i
& hold harmless the City of La Quinta, its officers, agents and employe s /
2. Any permit issued as a result of this application becomes null and voi f
work is not commenced within 180 days from date of issuance of S,
permit, or cessation of work for 180 days will subject permit to cancellat
I certify that I have read this application and state that the above informati is I
° correct. I agree to comply with all City, and State laws relating to the buil - ing
construction, and hereby authorize representatives of this City to enter upo
the,above-mentioned property for inspection purposes;
Signature (Owner/Agent) Date .e-1•
JOB SITE
ADDRESS
OWNER
46-510 ROU iR;1AKF,
LA QUANTA rti-A 92253
USE OF PERMIT
ONLY. 200).. CBC
FtERCtM
PERMIT #
04N-00
1
APN y
CONTRACTOR/DESIGNER/
79-605 1 .if -MAD
MUMMA DUNFS CA 92201
(760)346.420 Mh 432
12,�D0.00 1.S'
MWrFF,% SU.M . i6E
REROOF FRS' 101-000-418-000 $30.00
SUB-7"Ca'TAL CONMU iYO1`T,/ND Pry' C.5W—EC"K
APR 0 5.2004 )
COTy OF two G`Lcitt?"fq
FA.2,a n�.... _
RECEIPT I DATE`' ?_!� , ���/ I BY \ \ I DATE FINALED I INSPECTOR
IUMW
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$Qa30.f00
lsa oo
50.00)
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
P.'Vd Beam
Approval to Cover
`
Equipment Location
Underground Electric
Underground Pibg. Test
Final 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
E,-.',Ierior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Ublity Notice (Perm)
COMMENTS:
PALM DESERT CONTRACTORS/ROOFING
P.O. Box 2795 Palm Desert
California, 92261 Lic# 477507
760-346-2420 Fax 760-345-3924
DATE: 1-5-04
PROPOSAL submitted to;
William Frenken 619-440-5891
WORK to be performed at;
46510 Roudel Ln, L Q
Palm Desert Contractors/Roofing hereby proposes to furnish material and.
perform the labor necessary for the completion of,
Total removal of existing roof and re -roof as follows;
Pitch; Install 40 Ib base sheet, install Eagle lightweight the g 745, use ridge
and trim as needed, paint all roof jaxs. Use cement as needed.
Extras; Permit, plywood @$35.00 per sheet, extra painting, custom sheet
metal work, extra layers of roofing to be removed @$20.00 per layer per
square, taper system @$9.00 per sheet, vents @$75.00 per vent. Engineering
if any. Not responsible for any lawn damage.
5 Year contractor warranty.
The work will be performed in accordance with the drawings and
specification submitted. for the above work and completed in 'a workman like
manner for the sum of; $ 12842.00
With payments as follows: 10% down, Balance upon completion
Respectfully submitted
ACCEPTANCE OF PROPOSAL
The above price, specification and conditions are satisfactory and are hereby
accepted. Palm Desert Contractors/Roofing is authorized to do the work as
specified. Payments will be made as outlined.
Date Signature
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