05-0761 (RR)TAMPICO
ALIFORNIA 92253
BUILDING PERMIT
APN:
Application description
Property Zoning . . . . . .
Application valuation . . .
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
0.5-00006761 Q Date
77035 AVENIDA FERNANDO
658-240-040- - -
RE -ROOF
LOW DENSITY RESIDENTIAL
12000
3/07/05
Owner Contractor
ROBI.NSON DONALD L CZYK ENTERPRISES
4250 WILLIAMS RD P 0 BOX 1042
SAN JOSE CA 95129 YUCCA VALLEY CA 92286
(760) 228-2343 -
WCC: STATE FUND
WC: 2290023633 11/01/05
CSLB: 442748 05/31/05
CCC: C39
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Permit . . . . . . RE -ROOF
Additional desc
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 30.00
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Special Notes and Comments
RE -ROOF WITH URETHANE FOAM ROOF SYSTEM
OVER EXISTING B.U.R.
Fee summary Charged Paid Credited Due
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Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00. .00 .00 .00
Grand Total 30.00 .00 .00 30.00
4
P.O. Box 1504 • 4,4" VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING Bt: SAFETY DEPARTMENT
Application Number: o 5 " 7(c I I Date: 5-7'05
Applicant:
Applicant's Mailing Add
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
fj A
LICENSED CONTRACTOR'S 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
/' , and ss License is in full force and effect. yYL %d
icense Class �f i icense No.
C:rV72 A_
OWNER -BUILDER DECLARATy/
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for tIOfollowing reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
(_,) 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
WORKERS' 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' compensate n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued, M workers' compensation i ance camer�nd�p licy number are:
arrier sorer A—W-Wr. olicy Number G �Y oOZ31.33
_ 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 Califolara er a that, if I should ime subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with th a provisions. /
WARNING: FAILURE TO SECURE WORKERS' CO ATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DO RS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 1 have read this application and state that the above LkIfMrmation is correct. I agree to mply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this unty to enter the above -men i ned property for inspection purposes.
ate 3 �ignatureApplicant or Agent):
-- CZ'K ENTERPRISES'
SPECIALTY CONSTRUCTION SERVICES
P.O. Box 1042 Yucca Valley, CA. 92286-1042
(760) 228-2343 Fax (760) 366-7650
Contractor's License No. 442-748
PROPOSAL AGREEMENT AND GENERAL CONDITIONS
"Date: 217/05
Buyer: Mr. & Mrs. Robinson
Address: 77035 Fernando La Quinta, CA. .
Telephone: 760-771-9311 Cell: 408-483-02970 Fax:
Contact: Mr. or Mrs. Robinson
We propose to install a urethane foam roofing system .at the above noted address in
accordance with the following detailed specifications.
URETHANE FOAM ROOF SYSTEM OVER EXISTING B.U.R.
Preparation:
1. 'Obtain necessary permits
e,
2. Sweep clean loose gravel on existing roof and haul away debris
3. Prime entire roof deck at 1 gallon per 250 sq. ft as needed.
4. Mask necessary areas not to receive the foam application (walls, A/C's, etc.)
Urethane Foam Application:
5. Spray apply 1" of 2.5 to 3.0 Ib. nominal density foam to entire roof deck.
6. Add foam build up in low areas to improve severely ponding conditions.
7. Grind foam as necessary at drains / runoff areas to promote proper drainage.
Coating Application:
8. Apply acrylic elastomeric caulking at roof penetrations as a secondary sealant on top
of the foam application.
9. Apply acrylic basecoat @ 1 Yz gallons per 100 sq. ft.
10. Apply acrylic topcoat @ 1 % gallons per 100 sq. ft (White)
11. Ten year application will include granules incorporated in top coat
Final Work:
12. Remove all masking materials and over spray protection.
13. Rqmove all job related trash from job site.
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Robinson