0012-073 (RR)U)
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LICENSED CONTRACTOR DECLARATION
I. her9by 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 effect.
License # Lic. Class ! Exp. Date
Date 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.
( 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.
STATE FUND "
(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 j��ovisd'ons of Section 3700 of the Labor
Code, I s all forthwith comply with th., prai/isions.
Date: IIIA%w 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 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) `1 � Date t T 1, `
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 001.2-073 TRACT
121121AX $4,145JIdK+
JOB SITE
APN
ADDRESS
77-5-'50 CALLS GECf MA -TUA
- -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CAMP P(n*r t
BTJNDE ROOT -1146 & ASSOO nil, INC.
77.550 CALIF CIMRTAIMA
31435 VIALAI'ALM&9
LA QUb 1-A CA 92253
'iHOUWD PALMS CA 92296
('760)343.7355 MLR 3583
USE OF PERMIT
I�iC�.2.ANE0U8
MP.i- OP WITH 24 YEAR COMPOSITION S'HINCf.1S (CLASS A REQUIUD)
RER0001F 4.163,00 LS
LS'iTMA1' D Coir r 01r C(?M7YMIUC'1,10H
4,163.0
PkR1V ff M f3Lfi1i1MAIRY
]tXROOF Fn 101.000-418.400 S"100
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DIN
DEC 12
X17 Y kit- LA G2
[1
#p C
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flfJB4OTAL COMMUDCM0NAWD PL,AW C:1`ipJX
$30.00
IMS PRE•PAQ?IMSMI
$0.00
710TAL PERAW FEES llVE NOW
MOO
RECEIPT
DATE
' i
B (r' i /
ff f�
DATE FINALED
INSPECTOR
--:::I
0
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 Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
3437"4"--"... Ali -/b J 3 " 6 "' V 00:
r
t
B ME RWFMG & ASSOCIATES, DNC.
P -4y. Box• onsand Palms • CA 922276
(760) 343-7555 0 FAX (760) 3434554
5.:(746071-3321
Rc: Estimate re-toof shingles
77-550 Call (hluahua
La Quinta, CA 92253
FOR Tiles RM OF' .4,163.00
�„
....,C. L'I_r. a �1 a.. !�:7-1-71-7=7M.=7�l�7
Tear off existing roof and haul away. Inspect sheathing for dry rot, and replace any damaged wood on
a time and material basis at a race of 540.00 per sheet replaced upon approval of owner or his agent.
Re -roof with one layer #15 pound felt nailed to hold in place. Over felt install new 25 year self-sealing
dimeasional shingles to manufactures specifications. Imtall individual units of dura ridge on all hips
and ridges to compliment new roof. Clean and paint all roof flashing@ with resat proof paint, replacing
arW found to be defective. Haul away all debris caused f vw above work and kaw area clean. This
estimate inchsdea no ultras. If you have any questions regarding this bed please feel free to call. A five-
year guarantee will be in affect upon payment in full.
TERMS: 100% UPON' COMPLETION, UNT.ESS OTHER ARRANGEMENTS HAVE BEEN MADE.
.1 t ••, e• I: x 1 �
IT IS IMRP.BY AGREED BY BUNDE ROOFING & ASSOCIATES. INC. AND TM OWNER THAT WE
TIE CONTRACTOR SHALL NOT BE LIABLE FOR ANY OF THE FOLLOWING: DIRT, ROCK, OR ANY
DEBRIS THAT MAY FALL BETWEEN THE SHEATHING BOARDS ONTO LONG AREAS,
DAMAGES TO ANY CEII. NG MOUNTED FIXTURES, VENTS AND OR CONDUIT PIPES,
STRUCTURAL DEFECTS IN BUILDING_ IT WILL BE OWNER'S RESPONSIBILITY TO REMOVE AND
RELACE ANY ROOF MOUNTED ANTENNAS AND/OR SOLAR PANELS.
CONTRAGWW3 ARE REQL11 M BY LAW M BE LICEMM AND REGMAiED BY TIS,
GCT RACIEV S STATE LICMM BOARD.
1020 N STREET
SACRAMENTO, CA 95814 LICENSE # 691270
Respectfully submitted byData: Nmwnber 3.20()0
Accepted by:
NOU-09-2000 18:22 TEL) ID)eUNDE ROOFING PAGE:002 R=95%