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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 effect.
License # Lic. Class Exp. Date
Date { Signature of 6ontractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that -1 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.
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 Y)'ROT t'�?!.4&N1�104 �'T Policy No. I'krj G �7P 3VI
(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.
De: Y..: i r; i` 1 1 Applicant'
1, -
Warning: Failure to secure Workers' Compensation coveFage i3-Uliiawful 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.
BUILDIN,13 PERMIT MMM111013 � 4
DATE 81 wo3 VALUATION 6 l,4iC1lt,t "L' LOT TRACT
JOB SITE /}, 9 A H ay.,�' 4 ]� y' APN
ADDRESS 54,01 A 1?`i'c. x sl DA f.X_1y��f't
OWNER CONTRACTOR/DESIGNER/EN (NEER
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i :1"[?4'TA CA, 9228s M, R?,,'1iDA.tl{i1M2 CA 92,2.11 D
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USE OF PERMIT
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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. s� /
RECEIPT
Signature (Owner/Agent) ,' Dates I i
�ut�� ••',�;�A� ; ���n�pt:� � ttiyt �t�i� �.�ar� ���x,Atr �:.•il:�.
LEM YR17-P11.0 rElf V
DATE I BY '
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab 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 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:
,
RTS,
Roof Tile Specialty, Inc.
Contractors State License # 810537
P.O. Box 11257 Palm Desert, CA 92255
PHONE 760-200-0811 FAX 760-200-0801
A proposal submitted to: CARL SCHIERCSH
Mailing Address: 54021 AVE. CORTEZ LA QUINTA, CA 92253
Job Address: SAME AS ABOVE
Phone: 564-1895 &V&"2_
Description of work to be performed:
OBTAIN ALL REQUIRED CITY PERMITS.
REMOVE EXISTING SHINGLE ROOF AND DISPOSE, CLEAN ANY GUTTERS AND GROUND AREAS..
LOW SLOPE AREA INSTALL SBS MODTIED PEEL AND STICK.
INSTALL NEW ROOF JACKSON ALL PENETRATIONS WITH NEW PERIMETER METAL AND PRIMER.
HOT MOP TWO LAYERS GLASS PLY TO EXPOSED METAL EDGES SEALING TO ROOF.
INSTALL SHEET METAL AT ALL ROOF TO WALL TRANSITIONS. -
INSTALL LIGHT WEIGHT ROOFTILE TO MANUFACTURES SPECIFICATIONS.
CLEAN JOB SITE TO OWNERS STANDARDS.
IF NOT ACCEPTED IN 30 DAYS THIS PROPOSAL. IS NULL AND VOID
- Note: In keeping with industry standards: 1. This guarantee does not cover any -damage to the interior or exterior on which the roof
is applied or damage to any contents therein. This guarantee does not cover damage to roof due to any cause beyond our control,
including, but not limited to:. fire, lightning; windstorm, hailstorm, antennas or other equipment, foot traffic on roof, structural fault
or settlement, cra oro failureof the roof deck, walls or'foundation..ofrhe buildng on which the roof is applied. 2. Should it
become race y for the roofing contractor to remove and/or reinstall any antennas, cooling or heating appliances or other
equipme whether or not an charge. is made for such work, the customer understands that neither RTS (Roo£Tile specialty,
im.) novffie installer assumes any _respon ty for the performance of said equipment. 3. RTS (Roof ve spw ialty, inc.) does.not assume .
any rpiponsibility for corrections of existirk
code violations otfor the repair of any existing defects unless specified in estimate and.
TiCost: $11,600.00 Ti�rms paid completion unless, otherwise specified in the contract. If not accepted in thirty days this
pro is invalid. An additional cost 35.00 per sheet of plywood will be charged if plywood needs to be replaced.
Accep ce: You are hereby sutho ' to furnish all contents wntten:m the contract to complete work mentioned in the proposal
contract which Itwe agree to the amount.mentioned, in said proposal, and according to terms thereof, (initial).. If a
leakage, ca in workmanship, occurs within TEN years from date of application, we will repair defects free of
charge.
Installation: It is understood that by acceptance. of this proposalyou authorize RTS (Roo£Tiie specialty, ine.)•to make the installation;
to issue .work orders with specifications shown herein and to pay our charge for such installation. You agree to pay the amount
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 RTS (Roof Tile specialty, im). Verbal 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 merchandise, if due to fire, strikes, war, government regulations or any cause beyond our contract. Any
changes made by you in specifications herein,. necessitating additional materials or labor shall not.be included or covered by this
proposal, but shall be provided for under separate and additional order from you. (initial)
Arbitration of Disputes: Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall settled by
arbitrator in accordance with the applicable Construction Industry Arbitrator Rules of the American Arbitration Association which
are in effect at the time the demand for arbitration.is filed A judgment award based upon the evidence presented bythe party(ies)
who do (does) appear and participate. Notwithstanding Contractor's right to arbitrate, contractor does not waive any of its lien
rights. In the event of default by client in payment of the amount.due hereunder, client agrees to pay reasonable attorneys' fee's.and
cost incurred in connection with collection of said amounts whether or not :suit is filed. 1.5"/o per month and/or -an annual percentage
of,18.0%o will becharged on all' past due accounts. Contractor's are:required by law to be licensed and regulated by the Contractor's
State Board. Any questions concerning a contractor maybe referred to the register of the board whose address is: Contractors State
Licenses Board, 9835 Goathe Road, Sacramento, CA 95827. Mailing address: P.O..Box 26000, Sacramento; CA, 95826.
The above prices, specifications and conditions are satisfactory and are hereby accepted.
Owner's Signature
(or authorized. repr
Contractor's Signature
Date: & 0• 03
Date:'U �2_) (Q3
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