9612-057 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) c`ftivisi6i 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
/316547
C-19 713119
Date /' y Signature of Contractor
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 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.
K1 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.
A. i' T• ivj 95!5 i
(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 sous to become subject to the
workers' compensation laws of California, and agree that if I should become
sybject to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with those provisions.,
Date: ' t Applicant —�''� rte_
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 inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT
DATE 121 91w, VALUATION 4,(f, ltl.ti� LOT
PERMIT #CONTROL #
12467 T TRAC4453
T
JOB SITE ADDRESS 7=S-250 !FEV ; TJM0 O• E0 +S � Rk".>i<, ii APN "6464-016
OWNER CONTRACTOR/DESIGNER/ENGINEER
JUNE A N1+Ct-1ALIOVC AL MILLER& SONS 1100 °.ING
714230 Is./k, ill NICAI.E0-ST � 68760 S1.fMMU Ul.ciW
1.AQUIN'I'A (,A !91153 CNIT1110RAI l'i'd' C'A `)_2234
( (2111.4 106
USE OF PERMIT
(;V,NIs'kAi, AW1,FAN 0
i2I.,m vfI. f.sJS%iN4'A A3u0k i140 Ai40 KE-R.iX)F r#i iTLi1J ai F,k4 WI -f1.1 iliRF.E
PLY I I. -OT t2t)OF W/ CAP .3WEIEt'.
1t.i"A001"
irl.#N•�'��+'i�,.Mdt1 i,p1�.J1t 1JUV.�V
I.�.I;tt:Jfit� t"�2 tU1�f?(DC)-�iFi-t)Of) gitl.Crt�
StJfi-'IXTYAt.. CC.a?+ltT"t UC ITON AND PLAN (CREC
LESS Yt K t
.11
RECEIPT I DATE
TOTAL PERMIT FVFS OVE, NOW
DATE FINALED I INSPECTOR
w01
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
arty Wall Firewall
exterior Lath
D 1 - 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
O.K 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)
AL MILLER & SONS ROOFING CO., INC.
"BETTER ROOFS FOR BETTER LIVING"
?" '68&760 SUMMIT DRIVE, CATHEDRAL CITY, CA 92234 .
(619)• 346-T214-and 32&6616
A,S'FItTE LINS�E -'8657
PRS OSAL AND. FREE" ESTIMATE..—
j
Location of Job : ' La Quints, CA
CONTRACTOR OWNER
Mr. Michaelove
P.O. Box 1291 7R 75n RAii Tllmnton
La Quints, CA 92253 g64-1286 La Quinta
We propose to furnish the following materials and perform all labor necessary to complete the roof at the above location.
:'Roofer-to rawve flat decks down'to sheeting. 'Any damased'*pl"Wod needing to be
_ - rep per 4xg sheet . `c Roof to �then- t2 "taaeg
,
-r-type' 7.8 .glasbase ,to:1 deck, install two (2) layers 11# glasply hot mopped
t
". •--"-,betwwen-•layers with. 72#:glascdp embedded in a flood coat of asphalt. Electrical
y- ~ l nosunder. existing'hoof " tkp,•b, adressed by owner. Pitched roof price is for
re-roofing with lfteweig tile. '
•; . ° COIgMCTPRICE s ; Flat . areas- $6:; 560 :00 3
,.
EWSr
AI3;Of tFte above work tV.be cp yL�ti 1r a su6st$ntta!'artd �Irorcfnaiikke Fnaimer accbrdfi.g to st�tndald ljtcticea fav tbe, ° " t„
surAof $ R` Dollarg.(g 13. T'1ct-AA° -1
TERMS::Wet Ceaft on Co tion. '` "
'.
r ..P ATTENTION .. .. . ,
Section 7018
of the ContraLicense Law (B & P Code, Div. 3, Chapter 9) provides that starting July 1, 1988, everyone licensed by the Contractor's
License Board shall give a py 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 lic is required.
f
3 NOTICE
"Under the Mechanics' Lien Law (California Code of Civil, Procedure, Section 1181 at seq.), any contractor, subcontractor, laborer, supplier or other person
who helps to improve your property but: is not paid for hs work or supplies, has a right to enforce a claim against your property. This means that, after a
court hearing; your 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
paldygW-g vn.cootrgctor imfull, if tije_subyontragtot,fgborer, 91 s-upplier.Le<m8(_nsVnpaid.' _ " _ �; }:.: _ •,71-.•F_:_ __ �_. ,_-:«.
Miller Tyears
AI f Sons Roofing Co ;,Inc. agree,etotfurAlsh II a-reguIaf form if'Guardntee for 4 after completion df:itb wdrk!iila-guaram"—o:dover
'1
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
construbtion. 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. Al Miller & Sons Roofing Co., Inc. is not responsible for TV antennas.
We are fully covered by$` u kmen's compensation and public liability insurance. Carriers' names and policy numbers available on request.
Any alteration or deviation om 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 gqj�er sum mentioned in this proposal. All agreements must be made in writing. This offer is valid for one week from the date of
•
estimate and Is based on free ftcless 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 responslb[a for any damage tC'i dewalks curbs or drrveways
,Respectfullysubmitted'
`' E57litiF''NTE ' AL MILLER 6t,SOt RO )Flt CO tAt� r tt,
c.
4..
Accepted: 13y. lie
Mitthew'Miller.
Date: �� — le 6. Date: December 2, 1996
AL MILLER & SONS ROOFING INC.
68760 SUMMIT DRIVE
CATHEDRAL.CITY, CALIFORNIA92234
(619) 328-6616 or 346-1214 ; CITY bF,B_ A 01 I lkiTA
License No. 336547 DEC 2
REC°D
BUILDING Al u
December 19, 1996
City Of La Quinta
Building & Safety Department
P.O. Box 1504
La Quinta, Calif. 92253
To Whom It May Concern:
,,.,Please find attached a copy of`a permit which we pulled for a'reroof for
a Mr. Michalove at 78250 San Timoteo St., La Quinta, California. We.are
requesting a refund for the thirty dollars ($30.00) which we paid.for this
since Mr. Michalove hired another roofer.to do the work since we could not
work in the rain.
Your attention into.this,..mattet is greatlyappreciated. Thanking you in advance
for any help you can provide in this matter.
Sincerely,
Howard McAloney
General Manager
HMc:gmh
La�uvtt�,.� .
78-495 CALLE TAMPICO — LA. QUINTA, CALIFORNIA 92253 - (619) 777-7000
F `� OF TN�'� FAX (619) 777-7101
January 9, 1997
Al Miller & Sons Roofing Inc.
68=760 Summit Drive
Cathedral City, Ca. 92234
Attention: Mr. Howard McAloney
Re: Permit 9612-057
Dear Mr. McAloney:
Please find enclosed a check for $24.00 for the reroof permit, 9612-057, not performed at_7.8_250
�San Timoteo in'�La Quinta. Also enclosed is Uniform Building Code Section 107.6 which will
justify the discrepancy between the amount of the permit fee and the refund returned to your
Please feel free to contact us should you have any questions and we look forward to working with.
you again in the future.
Sincerely,
Mark Harold
Building and Safety Manager
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA. 92253 ��.
1994 UNIFORM BUILDING CODE
107.3-107.6
When submittal documents are incomplete or changed so as to require additional plan review or
when the project involves deferred submittal items as defined in Section 106.3.4.2, an additional'
plan review fee shall be charged at the rate shown in Table 1-A.
107A Expiration of Plan Review. Applications for which no permit is issued within 180 days
following the date of application shall expire by limitation, and plans and other data submitted for
review may thereafter be returned to the applicant or destroyed by the building official. The build-
ing official may extend the time for action by the applicant for a period not exceeding 180 days on
request by the applicant showing that circumstances beyond the control of the applicant have pre-
vented action from being taken. No application shall be extended more than once. In order to renew .
action on an application after expiration, the applicant shall resubmit plans and pay a new plan re-
view fee.
1075 Investigation Fees: Work without a Permit.
1075.1 Investigation. Whenever any work for which a permit is requited by this code has been
commenced without first obtaining said permit, a special investigation shall be made before a per-
mit may be issued for such work.
1075.2 Fee. An investigation fee, in addition to the permit fee, shall be collected whetheror not a
permit is then or subsequently issued. The investigation fee shall be equal to the amount of the per-
mit fee requited by this code. The minimum investigation fee shall be the same as the minimum fee
set forth in Table I -A. The payment of such investigation fee shall not exempt any person from com-
pliance with all other provisions of this code nor from any penalty prescribed by law.
107.6 Fee Refunds. -The building official may authorize refunding of any fee paid hereunder
which was erroneously paid or collected.
�. The building official may authorize refunding of not more than 80 percent of the permit fee paid
when no work has been done under a permit issued in accordance with.this code.
The building official may authorize refunding of not more than 80 percent of the plan review fee
paid when an application for a permit for which a plan review fee has been paid is withdrawn or
canceled before any plan reviewing is done.
The.building official shall not authorize refunding of any fee paid except on written application
filed by the original permittee not later than 180 days after the date of fee payment.
[For SFM] Other Fees. Pursuant to Health and Safety Code Section 13146.2, a city, county or
district which inspects a hotel, motel, lodging house, or apartment house may charge and collect a
fee for the inspection firm the owner of the structure in an amount, as determined by the city, county
or district, sufficient to pay its costs of that inspection.
Pursuant to Health and Safety Code Section. 1597.46, Large Family Day-care Homes, the local
'government shall process any required permit as economically as possible, and fees charged for
review shall not exceed the costs of the review and permit process.
Pursuant to Health and Safety Code Section 13217, High-rise Structure Inspection: Fees and
Costs, a local agency which inspects a high-rise structurepursuant to Health and Safety Code
Sec -tion 13217 may charge and collect a fee for the inspection from the owner of the high-rise structure
in an amount, as determined by the local agency, sufficient to pay its costs of that inspection.
Pursuant to Health and Safety Code Section 13235, Fire Clearance Preinspection, fee; upon re-
ceipt of a request from a prospective licensee of a community care facility, as defined in Section
1502, of a residential-carefacilityfor the elderly, as defined in Section 1569.2, or of a child day-
carefacility, as defined in Section 1596.750, the local fire enforcing agency, as defined in Section
j 13244, or state fire marshal, whichever hasprimaryjurisdiction, shall conduct a preinspection of
the facilityprior to the final fire clearance approval. At the time of the preinspection, the primary
fire enforcing agency shall price consultation and interpretation of the ftresafety regulations, and
shall notify the prospective licensee of the facility in writing of the specific firesafety regulations
1 10.11
4
DEMANDt/°CHECK REQUEST
,! -
v Return check to requestor
Mail check
Name / Title of person requesting check
K"41
Department individual is associated with:
. f
Check payable to:
AL MIIIFV,'f' #J S CAmount: $ w
(Name) endor No.)
Account Nur
(Address)/ A
.1 /d 409kG CITY, rA- q"L23 Project Num
a
Check description and invoice"number:
4
Ir -0
Signature:
T1 °
Department ea
(Date)
/
APPROVED FOR PAYMENT
(Finance Department Use Only)
' BY:
By.
ACCOUNT NO.
DESCRIPTION
s
I
Zx00349 - AL MILLER.& SONS ROOFING. 275 O 1 /96
Date Invoice Account Description Amount
12/30/96 9612-057 101 000 418 000 BLDG PERMIT REFUND 24.00-
24.00
1100 2 7 S9011" 1: L 2 2000 2 LBP: 2 L.689800 Lli' L L
is
C0G
- •
FIRST INTERSTATE BANK OF CALIFORNIA 02-27590
r I
Y
g
PALM"DESERT ESTATES#216
77-900 FRED WARING DRIVE
PALM DESERT, CA
CHECK NO.
" � " 11�/
92211
16-21/1220
y of THS P.O. BOX 1504, (619) 777-7150
i.5
78-495 CALLE TAMPICO, LA QUINTA, CA 92253
THE EXACT AMOUNT OF
ii
** TWENTY FOUR DOLLARS AND NO CENTS.**:
PAY TO THE ORDER OF:
DATE
AMOUNT -
12/31/96
*****24.00
¢'
AL MILLER & SONS ROOFING
6$'-760 SUMMIT DRIVE
CATHEDRAL CITY CA-
AUlHOR17,FD SIG
LIRE
92234-
;6
CIITNCI 17Ff1 CIi:N ATI IGF
1100 2 7 S9011" 1: L 2 2000 2 LBP: 2 L.689800 Lli' L L