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0012-003 (RR)F1 LICENSED CONTRACTOR 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 Code, and my License is in full force and elle t. License # Lic. Class Exp. Date Date �OWNERrIBLIILDER Signature of Contracto DECLA ATION 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 worker6 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 Policy No. (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 s as1to become subject to the workers' compensation laws of Californ'r an gree thaQ*f,,l,„should become subject o he orkers' compens ion.. o .is'/of Section 3700 of the' Labor k Code,/(s (r ith comply w' h e • r i ns. Date Applicant_ Warning: Failure to secure Workers' ompensation 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_become.s 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 Correct. I agree to comply with all Ci an construction, and hereby authorize r re66�✓e the above-mentioned property-fQ[in Signature hat the above information is laws relating to the building s of..this City to enter upon ✓'"� Date BUILDING PERMIT PERMIT# DATE VALUATION LOTTRACT 12104=1[ $9,3 om) JOB SITE APN ADDRESS 48-W” Xie. 0 r - OWNER CONTRACTOR / DESIGNER / ENGINEER sev^c eY OF DLEVECIM"IY `B9 '�r '��'�"� RQ C) ��� � 78-9.80 RWAWAY DAY HMOUDA MWES O`.A 92201 q'-2 2. f > USE OF PERMIT GENUUNL E09 -MGs *RER001Y 0.,ac Z %6 ''6U1f,,T41F R+ Off" h � VALUATION W FIMA-Mixf) CoRr.01P CON67ROMION IES $30, 06 h 131TA-7;"C►'xAY, dWM''1.KUr'T1 K A&3'iA`f'�(?���j1gqMI �(["���3'•��Rjj,,AX (('M pO��.(���Wyy TUI 1, MT9 PWOW RECEIPT DATE ��l1 2 r1 BY DATE FINALED INSPECTOR INSPECTION RECORD :t'. OPERATION DATE INSPECTOR OPERATION DATE- INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts i _ Slab Grade Return Air I Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. I Framing Compressor Insulation Vents I Fireplace P.L. Grills I Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall I Exterior Lath I Drywall - Int. Lath I I _ Final BLOCKWAL P�ROVALS Final i POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain i Bond Beam Approval to'Cover Equipment Location Underground Electric Underground Plbg. 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 1 Gas Test l Appliances I Final I 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: I . I I i j i I 4RO11 : PAUL -11 BURGER 8 CO. NPV ^i 06, (is,:?6p :.I1LUIRti a PHONE NO. : 913 3643233 Nov. 28 2000 12 42AM P P 1A proposal submitted to:PAUL HWGER Mailing Address: CONTRACTORS STATE LICENSE_ 0 636394 P.O. 13OX 11237 48390 EL N1DO LA QUiNTA, CA 92253 -Job Address: SAME AS ABOVE l(Phone: 1-913.3842333 FAX 1-91.3-38;-3233 Palm Desen CA 92255 760-'00-0811 1 i :13escription ofWork to He Performed: -- ��-- —_ - IREMOVE THREE LAYERS BUILT UP ROOF AND DISPOSE. ;NAII. ONE I.AYBR firLASS BASE iiJS'1'ALL ?JEW PER KETER FLASHINGS AND ROOF JACKS. HOT MOP THREE LAYERS GLASS P.L.Y. LOOD COAT ROOF WITH ASPHALT- I COVER WITH ROCK �-Please sigp contract and retum, keep second copy for your records. J Notes: in Keeping with Industry standards: 1. This guarantee does not cover any damage to the interior or ei-te- rior out which the roof is applied or d3mW w any contents therein.. This eparantee does not cover damage to roof due to any cause beyond aur control, including, but not limited to: Sri, lightning, windstorm, hailstorm, an- tennas or other equipment, foot traffic on roof, structural fauit or settlement, cracking or other failure of the. roof . deck, walls or foundation of the building an whist the roof is applied 2. Should it become necessary for the roof- ing contractor to remove and/or teinstali any antennas, cooling or holing appliances or other equipment, whether or not an additional charge is made for such work, the customer understands that neither Roof Tile Specialty nor EN installer assumes any responsibility for The performance of said equipment. 3. Roof Tiie Specialty does not assume any responsibitiry for corrections of existing code violations or for the repair of any existing defects un- less specified in estimate and proposal. Total Cost: 39,360.00 Terms paid on completion unless otherwise specified in the contract. if not acceptance in thirty days this proposal is invalid .Extra $35.00 per sheet of plywood if needed Acceptance: You are hereby authorized to famish all contents written in the contract to complete work mentioned in the proposal contract for which Uwe wee to pay the amount mentioned, in said proposal, and according to terms thereof, . (Initial). If a leakage. Caused by defects in workmanship, occurs within FIVE years from date of application, we will repair it £nee of charge. installation: it is understood that by the acceptance of this proposal you authorize Roof Tile Specialty to stake the installation; to issue work order with specifications shown herein ar-d to pay our clwrge for such installation You agree to pay the amount the specified herein, Which will cover the price of said materials and labor charge. This estimate is based on a complete job and any surplus material remains property of Roof Tile Specialty. Vedxd understanding and agreements with representatives shall not be binding unless set forth herein. There shall be no liabilities for delays in, or failure to complete. deliver or installation of all or any of the herein mentioned mer- chandise, if due to fine, strikes, war, government regulations. cr any cause beyond our contract. Ary changes made by you in apecifiGttions herein, neoessitating additional materials or labor shall not be included or covered by this proposal, but shall be provided for under separate and additional order frau you __ ( Initial). Arbitration of disputos: Any controversy or claim arising out of or relating to this contract, or the breach thereof. shall be settled by arbitrator in accordance with the applicable Construction industry Arbitrator Rales of the American Arbitration Association which are in efFeet v the time the demand for arbitration is filed A judgement upon the award rendered by the arbitrator(s) may be entered in court having jurisdiction thereof. Any arbitration award shall be subject to correction and/or vacation for the reasons stated in the code of civil Procedure. The ar- bitration shall award reasonable attorneys fees and expenses to the prevailing party- After being given due notice, should any party fail to appear at or participate in the arbitrator proceedings, the arbitrator shall make an award based upon the evidence pcemted by the party(tes) who do (does) appear ad participate. A'otwithwanding Corr tractor's right to arbitrate, contractor does not waive any of ita lien rights, In lite went of default by client in payment of the amount due hereunder. client agrees to pay reasonable anorneyC fee's and cost incurred in con- nection with collection of said amounts whether or not suit is filed I -S% per month and/or an annual percentage of 18.04o will be clku4ed on all post due accounts. Contractor's are requited bylaw to be licensed and regulated by the Contractor's State Board Any question concerning a contractor may be referred w the register of the bowd whose address is: Contractors State Licenses Board. 9835 Cioaihe Road, Sacramento, Ca., 95827. Mailing Address: P. O. Box 25000, Saar CA., 95826. The above prices are satisfactory and are hereby accepted Owner's S' __ _ Dale:_ _ /%/J6�0 4 (at authorized mauve) u 7 Contractor's Signatu -_ - Date: