0003-316 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter19 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Lic nse #235717 L _Glyass Exp. Da81i3U20i
Date • " 3 ° - `"' Signature of Contractor' ,—r-411-//`'
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
�eEtlon 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.
ST X1 : WND 0457621-99
(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
work�prs' compensation laws of California, and agree that if I should become
suJfect to the workers' compensation prove ions of Section 3700 the Labor
C6de, I shall forthwith comply with those =� po issJ on
bate: ?_fid' °" Applicant -�:.�! -�
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 seVforth 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.
01114 C.�' 3 -30-0
�,d'na'ture
(Owner/Agent)--" Date
3'30 " BUILDING
PERMIT PERMITNf„J".S_.)1b
DATE VALUATION
st'jilli Yf5m LOT TRACT
JOB SITE /i! -Civil 4-111 ltrc llu" i all
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DUKE BR.A.DSHAW
'%i'ES'1'ERN PACIFIC R0011INS.;
0-201 CALLE NORTE
.3462 LA CAMPA1+A it'A.7
LA QL11N'rA
CA 92253
MUM SPRINGS CA 92262
('760)416-51377 aCRIN
4293
USE OF PERMIT
GENERAL BUILDING
R6 -ROOF RR?v1a Q- GRAVEL REPLACE Wi TH. FOLYDRE 1 HANE FO,,kNi
REROOF
t
1, 3 00. 00 .L8,
+ � UMIATIM COS'' LSI' COiNSTRIUCYRDIN
1,34Iexo
PERMIT [I`F�5UNt11.[ARY
R.E42OOi� FEE
101-000-418.000 SY14M
SLII�•7Y7I'Ai. CpA}ST.IZUt i11 Af �Nti lit, �4ttf 6�MG�1;'
V41-60
LESS PRE -PAID PEES
$0.00
TOTAL PERMIT FEES DIFE NOW
$30.00
:I
RECEIPT
DATE
/
BYJIr
DATE FINALED
INSPECTOR
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 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
1FZ
Mhr&rl�
MO
Woofing Corporation
Duke Bradshaw
78-204 Calle Norte
La.Quinta. CA 9='53
RE: 78-204 Calle Norte La Quinta. CA 9=53
Application of a Polyuredmm Foam and Acrylic. Coating Roofing System.
Dear Mr. Bradshaw.
Thank you for the opportunity to inspect the roof on the above referenced property. We are Pleased to
submit our recommendations and proposalfor the installation of a polyurethane roof system. The
recommended scope of work and associated costs 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 cons action 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, materials, equipment, permim contractor's licenses,
insurance certifications, etc., to perfiorm'all operations required and specified The contractor
shall provide labor and material customarily included in work of the same natrre 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 unexpected condition.
D. The Contractor shall occupy, use; and permit others to use the premises only for the purpose of
completing the work to be performed under this contract with the Onner. 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 ai,=
E. Contractor's supe of work shall not inebude the identification, detection, abatement,.
encapsulation or removal of asbestos or similar hazardous substances. If Contractor encounters
any such products or materials in the course of performing its work. or if such hazardous
materials are encountered by any other fix *in performing work at the jobsite and contractor
determines that such materials pmt a hazard to its employees, contactor shall have the right
to discontinue its work and remove its employees from the. jobsite until such products -or
matenaLs, 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 contactor shall
receive an extension of time to complete its work hereunder and compensation for delays
encountered as a result of such situation and corre=om
3462 La. Campana Way • Palm Springs, CA 92262 • (760) 416-5877 • Fax (760) 320-8912
0
aw,"L;� SvLvcL wua oc temovea w vacuuming ana or power tmooming.
B. Roof deck shall be primed with Neoprime primer at the tate of ..33 to .50 gallons per 100 square
feel
APPLICATION OF POLYURETHANE FOAM A.YD COATING
A. Urethane foam insulation shall be sprayed -applied to a nominal thickness of I" (plus or minus
1/4 -inch). Only 3 lb& 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 coals of 22-24 Total Dry Mils.
C. During the final top coat application, size 411 granules will be embedded into the wet
top coat material at a tate 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 appearance, self
terminating flashing.
This specification meets manufacturer requirements, Underwriter Laboratory .
specifications and ICBG compliance. This system. when applied over an existing fire -
rated Class A or B built-up roof system has a UL 790, A classification. When applied
over an existing C rated roof system, the existing rating remains. RTC ICBG # ER 4630
TELE AREA
A. Replace all broken tiles and re -cement ridge board .� n
00-13 P;1 .Scs+nc.T.^-o H9 )JF•�ti`3o^.
CONTRACT AMOUNT 53,895.00
PAYMENT TERMS
10"/o deposit upon'approva! of the contract. Balance due upon completion and paid within 10 days of
receipt of.the invoice. -
W � 1' ��'K2. L�•LM..J (3aoi�
A Five (S) year tabor 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 art: munially desired; quality
installation, service reliability and long term performance: The price maybe subject to change 1S days
from the date of this proposal.
If you are is accordance with the conditions herein. please waste the agreement below and remm both
copies to this office. We will, in turn, sign them and return one copy to you. Thank you for your
cooperation in 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.
ACICtiOWLEDG1ZENiT. Owner acknowledges that he has read and received a legible copy of this
agreement including all 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 during this negotiation. Uwe
hereby acknowledge under the penalty of perjury that Uwe amiare the legal owners and am/are authorized
to sign this contract as an agent of the legal 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 cancel 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 tight to require contractor to have a performance and payment bond at owner`s expense.
DUKE BRADSHAW WESTERN PACIFIC ROO
: �'�.
Authorized Agent
1✓i s/ver
Tits ate
FING. CORP.
Contractors License # 235717
Authorized Agent
3
Title/Date
wem" PACDFIC ROOFING HAS THE RIGHT TO RESCLYD THIS CONTRACT wmmq Fu Tmv DAYS OF
ACCEPTANCE. THIS AGREE,NUM Is NOT BINDING t XIM ACCEPTED By THE OFFICE MANAGMMENT AT 3"2
LA CAAIPANA WAY, PALM SPRINGS CA M62. 40 CEEA,YGES OR ADDMOt4S TO.THIS AGREEMM SHALL HE
tYFECTIYE U` TM APPROVED B PAC37M MAXAGMENt:
NAXAGERS ACCEPTAN
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