0006-337 (RR)U)
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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. Dattep�
6 5U38 L" 9 �,/%� t OW 1121
e
� l 171 FJ,? Signature of Contractor;06--6e
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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 Gectian , D&RO. for thin 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 RMIANCK NATIO`f4A Policy No. )TWADI17769-06
(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, I shal forth y�ith comply with those provisions.
date: Applicant `F
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 bove-mentioned property for inspection purposes.
1 Signature (Owner/Agent)'%''�`�'�� Date
ft �
BUILDING PERMIT PERMITk
DATE VALUATION ////��yy�� �('{�LOT OW -337 TRACT
1iJ,'W/V.00
JOB SITE APN
ADDRESS .51^9W AVKMA CORM
OWNER CONTRACTOR / DESIGNER / ENGINEER
MRS Lt' MiMD
51.986 AMMA COR
LA QTJINTA
USE OF PERMIT
GEMAL BURDR40
CUSTOM ROOF MO CO.
38.980 RANCHO LOS COYOTES
CA 921.53 TltOD10 CA 92203
(760)343.3751 CD1.6 12
PJfMOVS ROCK AND RY.PL.:CE WITH ROCK
REROOF 3,400,00 LS
w
i y
FS�`.[!!�I'AM COFr OF CONSMiJC`.L ON ; e " 3 -00
PEMMr ME ,Humi"Pl.y
Rt 1001; FLS 101-000-418-000 $30.00
I rlw
SM -TOTAL CON "Ur'.C�ITC:°I ON AND PUN CI CK I $30.00
7 PRE -PATI) FUS $0.00
TOTAL 1'LW4 9' 1rM DOE NOW I 3*40100
RECEIPT I DATE I BV y \ I DATE FINALED I IN
i
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
0. 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
steel
POOLS - SPAS
Set Backs
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
Finch
Utility Notice (Perm)
COMMENTS:
CUSTOM ROOFING COMPANY CA LIC. NO. 625038 PROPOSAL NO. 2000054
38-980 RANCHO LOS COYOTES SHEET NO. 1
INDIA CA 92203 •
PRONE: (760) 345-3751
PROPOSAL AND CONTRACT
DATE: MAY 24, 2000
TO: MRS LIEBSHARD
JOB ADDRESS: 51-983 AVE CORTEZ, LA QU ,4TA CA
PHONE: 310-275-5020
SPECIFICATION AND UNDERSTANDING: Tear off existing roof and re -roof as follows: Nail
down l layer 'base sheet to roof deck: install new metal on edges: Install.3 layers nberglass ply -sheet, hot moped
between layers. Spread small crushed brown rock on top:.Custom Roofing Company,responsible for clean up
and removal of roofing debris from property., +
SPECIAL INSTRUCTIONS AND NOTES: (1). A deposit maybe required to cover the cost of
material. Draws on balance due may be required. (2). Any sheeting needed will be an extra charge of $30.00
per'sheet above contract price. (3). Any air conditioners, water coolers, duct work, electrical, etc., that needs
unhooked, moved; or removed from the roof will be the owner's responsibility .above contract ,price. (4). All
home owner's or association fees to be paid by owner above contract price.
COST: $3,400.00 (THREE THOUSAND FOUR HUNDRED DOLLARS AND NO CENTS.)
TERMS: TO BE PAID IN FULL ON COMPLETION UNLESS OTHERWISE SPECIFIED IN THE
CONTRACT.
FIVE(5)YEAR guarantee against leaks on Custom Roofing Company's work only.' ;
NOTE. BECAUSE OF THE RAPID RISE IN THE COST OF MATERIAL THIS PROPOSAL WILL BE
NULL AND VOID AFTER 15 DAYS JOB TO BE STARTED INA TIMELYMANNER ACCORDING TO
SCHEDULE AND WEATHER CONDITIONS.
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 any damage to roof due to any cause beyond our control including, but not limited to, fire, lightning,
windstorm, hailstorm, rainstorm, installation of antennas, or other equipment, foot traffic on root structural
fault or settlement, cracking or other failure of roof deck, walls ,or foundations of the building on which the roof
is applied. (2). Should it become necessary for the roofing contractor to remove and/or reinstall any antennas,
cooling or heating appliances, or other equipment, whether or not any additional charge is made for such work,
customer understands that neither Custom Roofing Company, nor installer assumes any responsibility for the
performance of said equipment. (3). Custom Roofing Company does not assume any responsibility for'existing
code violations or for the installation of any existing defects unless specified in the.estimate and proposal.
ACCEPTANCE: You are hereby authorized to furnish all contents written in this contract to complete
the work mentioned in the proposal and contract for which Uwe agree to pay the amount mentioned in said
proposal and according to the terms thereof.
IN KEEPING WITH INDUSTRY STANDARDS: It is understood that by the acceptance of this
proposal. you authorize Custom Roofing Company to make the installation, to issue work order with
specifications shown herein and to pay our charge for such installation. You agree to pay Custom Roofing
Company the amount specified herein, which will cover the price of said materials and labor charges. This
estimate is based on complete job and any surplus material remains the property of Custom Roofing Company.
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, governmental regulations, or any cause beyond our control.
Any changes nozde by you in. specifications herein Xcessitating additional materials or labor shall not be
T H E C I T Y O F
♦®o ♦
POW
Lainta
1982-19924 Carat Decade
February 19, 1992
To Whom It May Concern:
The structure located at 51-983 Avenida Corteziis located in
an "X" flood zone (Areas of 500 year flood; areas of 100
year flood with average depths of less than 1 foot or with
drainage areas less than l square mile; and areas protected
by levees from 100 year flood) per the revised;F.I.R.M.
(panel 060709 0005 B, effective August 19, 1991) for La
Quinta..
If you have any questions, feel free to contact me.
Sincerely,
BUILDING AND SAFETY
Tom Hartung
Director of Building and Safety
TH/lc
i.
city of La Quinta
Post Office Box 1504 ♦ 78-105 Calle Estado
La Quinta, California 92253
Phone (619) 564-2246, Fax (619) 564-5617
Design 8 Production: Mark Palmer Design. 619.346-0772
d