0003-315 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penqlty of perjury that I am licensed under provisions of
'''hapter 9 (commencing with Section 7000) of Division 3 of the Business and
I,• rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
235717 C-39 01/31120(
ate Signature of Contractor j ✓ , -y�
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 issu'�ed. My workers' compensation insurance carrier & policy no. are:
Carver STATE F,U13U Policy No. 0457644-99
(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 proviVns of Section 3700 of the Labor
Code, I shall forthwith comply with those r -Gisions.
Date: -P- 7....,. 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 seiXforth 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) /Z , / /% / / Date—
e
��
�U •(�J BUILDING PERMIT PERMIT����
/�
'D TE VALUATION $1.310.00 LOT TRACT
JOB SITE 78-2116 CAI.LE 1�OR'TE
APN• _
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ROBERT HAYDEN
� WESTERN PACIFIC RWFING
7842 6 CALLL NORTE
346+2 LA CA.tti'IPANA NWAY
LA QUINTA CA 92253
PAL.N4 SPRINGS CA. 92262
(760)416-5877 CBfA 4293
USE OF PERMIT
GENERAL BUII,DfNGx
RE -ROOF RElViLOVE GRAVEL REPLACE '%'I T H POarWi2t TIiiANNE 1, 0 A
Ri3RC)O 1.300.00 LS
ESTIMATE COST OF CONSTRUCTION
1.3011.11€1
PERXIIT FEE SUNINIARY
REROOF FEB 101-()OA-�M1I3-000 s3u.0o
SUB -TOT -AJ, CON *K 171J 7N AND PLAN CELS'.
$30.00
LESS 11RE-11A.1U I- _UES
$O.Ot)
TOTAL PERMIT FE&S OVE-Nt3W
530.00
7
RECEIPT
DATE
'BY'
DATE FINALED
INSPECTOR
r �;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I 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 8 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:
WESTERN PACIFIC
:vtarc T.�3t o
Robert Hayden
78-206 Calle Norte
Kooling Corporation
La Qainta. CA 92253
RE. 78-206 Calle Norte La Quinta. CA 92'253
Application of a Polyurethane Foam and Acrylic Coating Roofing System,
Dear W Hayden:
Thank you for the opportunity to inspect the roof on the above referenced property. We are pleased to
submit our recommendations and proposal for the installation of a polyurethane roof system. The
recommended scope of work and associated casts are as follows:
GENERAL
Unless expressly stated to. the contrary, the contractor shall be responsible for performing the following
acts.
DESCRIPTION
A. The general conditions of this standard construction contract shall form a part of these
specifications with the same force and effort as though repeated herein.
B. The contractor shall furnish all labor, ma ars, equipment, permits, contractor's licenses, .
insurance certifications, etc., to perform all operations
required and specified Thecontractor
shall provide labor and material customarily included in work of the same nature to give a
quality, complete job.
C. If unexpected conditions are encountered during the work. and the conditions adversely affect the
cost or progress of the work, the contractor will notify the owner immediately, and the owner will
negotiate a change -order to resolve the un, -ted condition.
D. The Contractor shall oaaupy, use, and permit others to use the premises only for the purpose of
completing the work to be performed under this contract with the Owner. The Contractor shall
not authorize or permit any other person to use said premises for any purpose whatsoever.
Western Pacific is to be given all reasonable set-up and staging areas.
E. Contractor's scope of work shall not include the identification, detection. abatement,
eac�sulaaion or removal of asbestos or similar. hazardous substances. If Contra= encounters ...
any such products or materials in the course of performing its work, or if such hazardous
materials are encountered by any other firm performing work atthe jobsite and contractor
determines that such materials present a hazard to its employees, contractor shall have the right
to disconuntie its work and remove its employees from the jobsite until such products or
materials. and any hazards connected therewith, are located and abated. encapsulated or
removed, or it is determined that no hazard exists ( as the case may require), and contractor shall
receive an extension of time to complete its work hereunder and compensation for delays
encountered as a result of such situation and correction..
3462 La Campana Way • Palm Springs, CA 92262 • (760) 416-5877 • Fax (760) 320-8912
Robert Havden �•
Msrch 13.2000
Page 2
SURFACE PREPARATION
A. Surface gravel will be removed by vacuuming and or power brooming.
B. Roof deck shall be primed with Neoprime primer at the rate of .33 to .50 gallons per 100 square
feet
APPLICATION OF POLYURETHANE FOAM AND COATING
A. Urjhane foam insulation shall be sprayed -applied to a nominal thickness of 1" (plus or minus
1/4'inch). Only 31b3. density foam will be used in this application.
B. Coating shall be applied in a minimum of two (2) separate coats. Acrylic coating to be 60% .
solids. ( plus or minus 2%).
a. The base coat shall be applied at a rate of 1.50 gallons per 100 square feet.
b. The top coat shall be applied at a rate of 1.50 gallons per 100 square feet, yielding a
total system thickness for both coats of 22-24 Total Dry Mils.
C. During the final top coat application, size #I I granules will be embedded into the wet
top coat material at a rate of 50 pounds per 100 square feet Topcoat color LIGHT
GRAY.-
d. All foam is to be coated Coating shall extend up and over all foamed vent pipes and
terminated a minimum of 2 inches above the foam. creating a neat appeartan, self-
terminating flashing.
This specification meets manufacturer requimments, Underwriter Laboratory
specifications and ICBG compliance. This system- when applied over an eisting fire-
rated Class A or B built-up roof system has a UL 790, A classification. When applied
over an e:dsting C rated roof system, the existing rating remains. RTC ICBG. # ER 4630
TILE AREA
A. Replace all broken tiles and re-cement ridge board
coNTRACT AMo>Q1vT s3 - � � w� �— y� " '� oa, Lf
PAYMENT TERMS 3 V,5�
100/0 deposit upon approval of the contract. Balance due upon completion and paid within 10 days of
receipt of the invo=
l,J l J � 1,..4, 0��,� 3.. rs •
wEMMLV PACIFIC '
Robert Havden
March 13, 2000
Page 3
WARRANTY
A Five (5) year labor and material warranty will be issued upon completion of the roof and final payment
is received
The price quoted has been structured to reflect standards we assume are mutually desired quality
installation. service reliability and long terra' performance. The price may be subject to change IS days
from the date of this proposal-
if
roposal
if you are in -1 rdance with the conditions herein, please execute the agreement below and return both
copies to this office. We will. in tum sign them and return one copy to you. Thank you for your
cooperation4it expediting this contract for your roofing needs.
NOTICE TO OWNER
Contractors are required by law to be licensed and regulated by the Contractor's State License Board.
Any questions concerning a contract may be referred to the Registrar. Contractor's State License Board.
P.O. Box 26000, Sacramento, California 95826.
ACIGYOWLEDGMENT: Owner acknowledges that he has read and received a legible copy of this
agreement including aiI terms and standard provisions before any work is performed and that he has read
and received a legible copy of every other document that owner has signed doting this negotiation. Uwe
hereby acknowledge under the penalty of perjury that Uwe am/are the legal owners and am/are authorized
to sign this contract as an agent of the Iegal owner.
ACCEPTANCE: The above prices, specifications and conditions are satisfactory and are hereby
accepted. You are authorized to do the work as specified. Payment will be as outlined above. You,
the buyer may cancei this transaction at any time prior to midnight of the third business day after
the date of this transaction. See the attached .Notice of Cancellation for an explanation of this right.
Owner has the right to require conuactor to have a. performance and payment bond at owner's expense.
ROBERT HAYDEN / WESTERN PACIFIC ROOFING. CORP.
/ Contractors License # 235717
Authorized Agent Authorized Agent
TidelDate Title(Date
wESrERN PACIFIC ROOFL*fG HAS THE RIGHT TO RESCMD THIS CONTRACT wrrffor FIFTEEN DAYS OF
ACCEPTANCE. THIS AGREE<KENT Is , torr BL` me U tTM ACCEPTED BY THE OFFICE MAXAGENMNT AT 3462
LA CAMPA,YA wAY. PALM SPRINGS. CA9ZZ62. YO CHA,YGES OR ADDRTONS TO THIS ACREEMELNT SHALL BE
EFFECTIVE U&XM APPROVED ACIFIC MANAGE1N NT.
MANAGERS ACCEPTANCE: DATE_�� '