0305-108 (RR)16 .
N_ W
r` 0
' W
o Z
((DD 0
JV(D
W W
f- a
N
Z
co
LO
N
ON
U_ °)
W Z
Lo H ac
0
tL
X W —
0 -'
mQ
VU
O
la: 0)
,'I- Z_
oo Z)
0;
Q
LICENSED CONTRACTOR DECLARATION
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 effect.
License # Lic. Class Exp. Date
741152 C39 1Oki 112S
rj�C' 0-" , ignature 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 STATE f�'fi9:M,) Policy No. 221-0012K-2002 .
(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 provisions of Section 3700 of the Labor
Code, l shall forthwith comply with those provisions.
,Date:" r5 Applicant
Q r � �
Warning: Failure to secure Workers"Compensation-coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions. and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued asa result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date,of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.for inspection purposes.
Signature (Owner/Agent)'''"_. -�' �V Date
BUIL. fG PERMIT PERMITk
DATE VALUATION LOT `-�$ TRACT
IM -IMM 6-3000.00
JOB SITE
ADDRESS AU265 AW -ROM JUAR
APN
_ -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1`1M)KR1 CORN -M-1-
PRID-TFC11 RC}0._VM- •G Co. _
53-2,65 AMMAJUr--M
78-670HIGHWAY 911 YTE 185
LA Qi3:il�f`�'.A C'A. 9225:3
LAQUWA CA 92253
(760)360-F$099 EISL4 1925
USE OF PERMIT
C:%1ai+'1'?UL �'J71'. 3!` G
R&ROOF 0ARAIDE—ANt3 PMAR BATT. W ITki'.Ci A5S'A9 .MATZRJAL
VALUATION ?,800,00 1,9
' ESSI.,ES7IAT3:,cA✓..'L•OST.3Id.' c4fd.Y.@7S,H•6'1r Srp8.. om
., L�if4YV tS
!Ei',:' OF ME' 1.01-000.418.000 3fd,4a
6MMUC:r;.0014
SUB -TOTAL AIM PLAW CHUCK
L90 PRE -PAW FEW
$30.00
$0.00
)?.CR1i f M. -S W iFdONY
MAY 1 2 2003
CITY OF LA QUIfYTA
FIN NCE DEPT: '
Vl. oo
RECEIPT
DATE
BY
D IN LEq/INSPEC
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
D I -Int. Lath
d �U
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)
4 ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
PRO -TECH ROOFING, INC.
78-670 HIGHWAY 111 SUITE 185
LA QUINTA, CA 92253
(760)360-8099
LIC.# 741152
NAMEIADDRESS
FREDRIKA CORNELL
PH
FX
CIN or I=rVTA
MAY l 2 RECD
PUIL®ING A14L SAFE -1-y
DESCRIPTION
REROOF W/ 4PLY B.U.R
PROPOSAL
DATE
PROPOSAL#
5/6/2003
2468
JOB ADDRESS
53-265 AVENIDA
LREMOVE EXCISTING FLAT ROOFS TO SHEETING, REPLACE ALL NECESSARY
PLYWOOD @40.00 PER SHEET, .
2..INSTALL 1PLY #28 GLASBASE NAILED TO SHEETING.
3: INSTALL 2PLY #11 GLASPLY MOPPED BETWEEN EACH LAYER.
4. INSTALL 1 PLY #75 GLASCAP MOPPED OVER PLYS.
5. INSTALL NEW TILE TO REPLACE BROKEN.
6. CLEAN UP JOB.
7. NOTE ALL A/C DISCONNECT AND RECONNECT TO BE PAID FOR BY OWNER.
8. PERMIT TO BE PAID FOR BY ROOFING CONTRACTOR.
5 YEAR WARRANTY ON NEW ROOFING
TOTAL
3,830.00
Thank you for your business. V
David Krastel, Presiden
TOTAL _ $3,830.00
ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE
AS OUTLINED ABOVE. . ,/
SIGNATURE