0103-045 (RR)_
LICENSED CONTRACTOR DECLARATION
I hereby affirm under pen'�lty of perjury that I am licensed under provisions of
-Chapter 9 (com m"enci ng "'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
P Date 'Z - 2 -Signature of Contractor -
OWNER -131.11 ILDER DECLARATION
nhereby affirm under penalty ofperjury that |umexempt from the Contractor's
^LiconseLow for thefollowing reason: `
1, as owh6r of the property, or my employees with wages as their sole
ill do the �iork, and the structure is not intended or offered for
,,,compensation, W.
pr perty, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Date Signat6re of Owner
AVORKER'S COMPENSATION DECLARATION
I hereby aff irT,,',',u'hde'r lSehalty of. perjury one of the following declarations:
I have anaskvill, maintain a ceitificate of consent to self -insure for workers'
compensation, as-OQvided for b� Section 3700 of the,Labor Code, for the
)T have andwill maihtain.Wo&rs' compensation insurance, as requir;d by..
Sdttion 3700 of the Labor Cdad,-.4604he performance of the work for which this
permit, is Issued. M� Worke�s', compensation insurance carrier & p'olicy,no. are:
Cartier .�Policy No.
(This section need not be com�leted if the pelrmit valuation is for $100.00 or less).
( ) I certify that in the performaAce of the W6rk 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 th�t if I should become
subject to the wo�kers' compensation provisions of Section Ir 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Applicant—
Vwa . rnin§: Failure to., , secure Workers' Compensation coverage is unlawful and
shall subj, e6tart.'e'irf'016�er to criminal penalties and civil fines up to $100,000, in
addition tb'the,'cbst of -compensation, damages as pi�pvided for in Section,.3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application ishereby made mthe Director of Building and Safety
for a permit subject to the oonunmno and restrictions, set forth on his
application.
1.Each person upon whose behalf this application is -made meach person ,m
whose request and for performed under or pursuant to
any permit issued auoresult nfthis appnoatonagrees m/Ishall, indamniyy�
uhold harmless the City o/LoOuinta. its officers, auentdand employees.
2. Any permit issued as u ,aou|t of this application Uouomoa null and void if
work is not commenced within 180 uoyo from date o, issuance of such
po,mit, ordoauoxion ofwork for 180 days will subject permit mcancellation.
-
| certify that | have read this application and state that the above information io
correct. | agree mcomply with all City, and State laws relating tothe building
cuhstmmivn, and hereby ,ep,600nt�ivov of this City to enter upon
the above-mentioned / .
SxgnommKOwner/AQemA Date
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APIN
ADDRESS
(5WNER
CONTRACTOR/ DESIGNER/ EN61NEER
Ind RE 0D
48-703 SMITAT-TYUMIA
34 62 1A CAYMAXA WAY
71WA CA 92253
I?ATM Spmwas CA. 91262
USE OF PERMIT
RKROOF I's
T ST OF COMURTr(M. ON
NSTMU IM C04
4,5W.00
AFAWN? AM
TLYTALEMMUMMSDUk
DATE
BY�
DATE FINALED
INSPECTOR
�
�
_
--^---``~-^-
'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ' "
r
Ducts
Slab Grade
Return Air
Steel _ _
Roof Deck -,5-'L7% 6�L
Combustion Air
Exhaust Fans
0. 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:
o ,
Se -:t S}:: INEST`=RN PACIFIC ROOFING CORP.; 760 320 8912;
1949
Roofing Corporation
l,ic, #235717
Mar -2-01 3:36PM; Page 1
TO:
P
Feorua�y 2, 2001
Jinn .lames
48701 Santa Ursula �i (o•'T'`"j
La , CA 92253
RE, 48701 Santa ljnuta, La Quint&, CA 92253
Ineitallation of new polyurethane roof system and option for new tile and underlayment
Dear Mx. R=d:::
Thu& you for the opportunity to submit a proposal for the replacement of the roofing system at the above
re¢erented. property. The recommended scope of work and associated costs are as follows:
SCOL OF WORK FLAT AREAS
A Surface gravel will be removed by vacuuming or power brooming.
B. Remove any contaminants that will interfere with the adhesion of sprayed urethane foam to the
submte. Surface shall be free of loose particles.
C. Roof deck shall be primed at rate of .33 to .50 gallons per 100 square feet.
D. Install new perimeter edge metal. (Unpainted).
APPLICATION OF POLYURETHANE FOAM A14D COATING
A. Urethane foam insulation shall be sprayed -applied to a nominal thickness of 1" (plus or
minusl/4").
B. Coating shall be applied in a minimum. of two (2) separate coats. Acrylic coating to be 60%
solids (plus or minus 2%).
1. The base coat shall be applied at rate of 1.50 gallons per 100 square feet.
2. Tho top coat shall be applied at a rate of 1.50 gallons per 100 square feet, yielding a
total system thicknos for both coats of 22-24 Total Dry Mils.
3. During the final top coat application #11 granules will be embedded intra the wct top
co* material at a rate of 50 pounds per 100 square feet. Top coat color LIGHT GREY
4. All foam is to be coated. Coating shall extend up and over all foamed vent pipes and
terminated a minimum of 2 inches above tate foam, creating a neat appearance, self -
terminating flashing.
This specification meets manufacturer requirements, Underwriter Laboratory
specifications and ICBG compliance. This system, when applied over an existing fire -
rated Class A or B built-up roof system has a UL 790, A classification. When applied
over an existing C rated roof system, the existing rating remains. RTC 1CBO #ER
4630
;462 La Campana Way • PaIm Springs, CA. 92262 • (760) 416-5877 •lax (760) 320-8912
www.west.pacroofcum • E-mail: wprcp,;@ westpacroot'.com
Sent Sv: kNESTERN PACIFIC ROOFING CORP.; 760 320 8912;
Mar -2-01 3:37PM; Page 2/4
Jim Reed
b COa�a�ry 2, 2601
Page 2 .
SCOL OF WORK TILE AREAS
1. Remove the existing tiles and discard.
2. Remove all debris from the roof deck
' 3.. install two layers #40 underlayment mechanically fastened.
4. Install Redlands Baja file to miamufacturers' specifications
S. install new 2" x 6" ridge board and mortar.
CRICKET AREA
1. Install one layer of # 27 glass base sheet mechanically fastened.
2. Install one layer of mineral surfaced modified bitumen sheet torch applied
3. Leave project in a broom clean condition.
CONTRACT AMOUNT FLAT AREAS 54,548410
Pl YNgENN'1 TERMS
10 % di posit upon signing of the contract and the balance due upon completion. Invoice to be paid within
10 days of receipt.. .
WARRANTY
A five (5) year labor and material warranty will be issued upon completion of the roof and final payment
• . i5 recc�ed.
Theprice quoted has been structured to reflect standards we assume arc mutually desired. Quality
installations, service reliability and long term performance. The price may be subject to change 15 days
from L?ie date of this proposal.
RN Pimc
mM
=_—_RN PACIFIC ROOFING CORP.; 760 320 8912; Mar -2-01 3:37PM; Page 3/4
S ATTS LAW R] {QUIRES ANYONE WHO CONTRACTS TO DO CONSTRUCTION WORK TO BE LICENSED BY
' L7 CO:t"I�CTORS STATE LICENSE BOARD IN THE LICENSE CATEGORY IN WHICH THE CONTRACTOR L5
To BE WORT TG -IF THE TOTAL PRICE OF THE JOB IS SS00 OR MORE (INCLUDING LABOR AND
77JAT S)
" _ "C �xS%D CONTRACTORS ARE REGULATED BY LAWS DESIGNED TO PROTECT THE PUBLIC. IF YOU
0071:"CT Writ SOMEONE WHO DOES NOT HAVE A LICENSE, THE CONTRACTORS STATE LICENSE
BOARD MAY BE UNABLE TO ASSIST YOU WITH A COMPLAINT. YOUR ONLY REMEDY AGAINST AN'
'"`Tlmm COI(TRACTOR MAY BE IN CIVIL COURT, AND YOU MAY BE LIABLE FOR DAMAGES ARISING
= ' i AXY INJVBJES TO THE CONTRACTOR OR HIS OR HER EMPLOYEES.
L P''1.Y CONTACT THE CONTRACTORS STATE LICENSE BOARD TO FIND OUT IF THIS CONTRACTOR HAS
-« LICEXSE. THE BOARD HAS COMPLETE INFORMATION ON THE HISTORY OF LICENSED
CONTRACTORS, INCLUDING ANY .POSSIBLE SUSPENSIONS, REVOCATIONS, JUDGMENTS, AND CITATIONS.
BOARD HA5OFFiCES THROUGHOUT CALIFORNIA. PLEASE CHECK THE GOVERNMENT PAGES OF THE
V`FU PAGES POR THE OFFICE NEAREST YOU OR CALL 1-800-321-CSLB FOR MORE INFORMATION."
y. NOTICE TO OWNER
"UNDER THE CALIFORNIA MECHANICS' LIEN LAW, ANY CONTRACTOR, SUBCONTRACTOR, LABORER,
OR OTHER PERSON OR ENTITY WHO HELPS TO IMPROVE YOUR PROPERTY, BUT IS NOT PAID
_n- : t� GR HER WORK OR SUPPLIES, HAS A RIGHT TO PLACE A LIEN ON YOUR ROME, LAND, OR
r ROPERTY WHERE THE WORK WAS PERFORMED AND TO SUE YOU IN COURT TO OBTAIN PAYMENT.
7-7S _V'RAI S THAT AMR A COURT HEARING, YOUR HOME, LAND, AND PROPERTY COULD BE SOLD BY A
COF:.FiT OMCER "ND THE PROCEEDS OF THE SALE USED TO SATISFY WHAT YOU OWE, THIS CAN HAPPEN
r'_v-P;"i TF YOIJ HAVE, PAID YOUR CONTRACTOR IN FULL IF THE CONTRACTOR'S SUBCONTRACTORS,
'.i CR .3VFFL ERS REMAIN UNPAID.
TO 7FUSSEIt"w'E THEIR RIGHTS TO FILE A CLAIM OR LIEN AGAINST YOUR PROPERTY. CERTAIN CLAIMANTS
SUCa AS SUBCONTRACTORS OR MATERIAL SUPPLIERS ARE EACH REQUIRED TO PROVIDE YOU WTm A
P4CI MI T CALJED A "PRELIMINARY NOTICE." CONTRACTORS AND LABORERS WHO CONTRACT WITH
OWNERS DIRECVLY DO NOT HAVE TO PROVIDE SUCH NOTICE SINCE YOU ARE AWARE OF THEIR
NIS a ANNE A5 AN OWNER A PRELIMINARY NOTICE JS NOT A LIEN AGAINST YOUR PROPERTY. ITS
;,"ST, LS TO :NOTIFY YOU OF PERSONS OR ENTITIES 77KAT MAY HAVE ARIGHT TO FILE A LIEN AGAINST
YOU':. PROPERTY 1F THEY ARE NOT PAID. IN ORDER TO PERFECT THEIR LIEN RIGHTS, A CONTRACTOR,
C-C!?CONTRAC'TO*, SUPPLIER, OR LABORER MUST FILE A MECHANICS' LIEN WITH THE COUNTY
RECORDER WFUCH THEN BECOMES A RECORDED LIEN AGAINST YOUR PROPERTY. GENERALLY, THE
:ZMAAZKUM TIME ALLOWED FOR FILING A MECHANICS' LIEN AGAINST YOUR PROPERTY IS 90 DAYS AFTER
F"-5T^YnAL COAMETIONOTYOUR PROJECT.
'O TRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRAC'T'ORS
S.A.,E LICENSE, BOARD, WHICH HAS JURISDICTION TO INVESTIGATE COMPLAINTS AGAINST
CONTRACTORS IF A COMPLAINT REGARDING A PATENT ACT OR OMISSION IS FILED WITHW FOUR
YEARS OF THE DATE OF THE ALLEGED VIOLATION. A COMPLAINT REGARDING A LATENT ACT OR
0:+USSION PERTAINING70 STRUCTURAL DEFECTS MUST BE FILED WITHIN 10 YEARS OF TIM DATE OF
�E ALLEGED VIOLATION. ANY QUESTIONS CONCERNING THE CONTRACTOR MAY BE REFERRED TO
L rM RLGzSTRAX CONTRACTORS STATE LICENSE BOARD, POST OFFICE BOX 26000, SACRAMENTO,
".'r' UTFOR_WA 9-376.11
'.'.`ES i CRN PACIFIC ROOFING CORP. ; 760 320 8912;
Mar -2-01 3:37PM; Page 4/4
h
.sHSi9 ��°Qt
FebrogrY 2, 2001
Page a
Tf y,ou are in accordance with the terms enclosed please aiecute the agreement below.
NOTICE TO OWNER
Con t;amrs are mpired by law to be licensed and regulated by the Contractor's State License Board.
t.
Auv cordons concerning a oontract may be referred to the Registrar, Contradtor's State License Board,
S• O. Box26000, Sacramento, California 95826
ACKNOWLEDGEMENT: towner acknowledges that he has read and roaeived a legible oopy of this
agmcment including all terms and standard provisions before any work is performed and that he has read
of _ other do oment ti�k.the owner has s' this negotiation,
atacl resod a ��4oPy �rY ...........:.. �: duang
11rie 1 * acknowledge under the. penalty of'petury that 1f mlare auftrized
To sigq this contract as an agent of the lcgal owner.
ACCF,VrANCE: The above prices, specifications and conditions are satisfactory and are hereby
aoceptCd. You are amtborized to do the work as specified. Payment will be as outlined above. You,
the buffer may cancel this transaction at any time prior to midnight of the third business day liter
fire dark of tihh1rausaaction.. Owner etas the rlgbt to require contractor to have a performance and
Pavme lit bound at owner's expense.
AGREED TO AND ACCEPTED BY:
Jim RkED WESTERN FACEFIC ROOFING, CORP.
Contra r s License # M. 717
u torized AgM Authorized Agent
Title title
#Date Date
WESTERN PAC FIC ROOFING HAS THF RIGHT TO RES ND THIS CONTRACT WITHIN VIFTEEN DAYS OF
ACX;MANCF. THIS AGREEMENT IS NOT BINDING trW11. ACt:'EPTED BY THE OFFICE MANA,GEM NT AT 3462
LA CA.DPANA WAY. PALM SPREiGS, CA 92=. NO CHANGES OR ADDrrIONS •CO THIS AGRERMP-NT SHALL Bii
Fs'IEC1kIVEUNTIL APPItOVA ",^v'']I ICiPIC,lMANACMENT.
MANAGERS ACC'EPTANCtt: ATE U
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