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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
691270 0{i/:5012{
Date ?A P � Signature of Contra
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 Ff.IND Policy No. 2551704-03
(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 oaf Section 3700 of the Labor
'Code, I shall forthwith comply with.those provisions.
Date: r , a —Applicant
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 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,fo`r inspection purposes.
Signature (Owner/Agent) - Date
BUILDING PERMIT PERMIT#
aui2-•.-+cry
DATE VALUATION LOT TRACT
0=3121K VALUATION
JOB SITE
APN
ADDRESS A'9 -MO AVMIUA CC?72'iICY,,
`
OWNER
CONTRACTOR / DESIGNER / EN (NEER
k7, 7RM A SAD7LER
BTT14DE ROOFING A ASSOCLI;ISS, INC.
51.860 AVERIDA CORTEZ
-314 35 VIA 1..A. PALM AJ'
LA Q1 4 A CA 92253
MOUSAND PAIM.2' CA 92216
(760)343.7555 CIAX 3583
USE OF PERMIT
01NMkL,T1TT1LDNG
ftP'�ROOi*/StilNCtt.%S!L'I.Au9 "A" lytgl`�IifAi.S ONLY.
VALUATION 61935,00 LS
tr;,yJ MA'T ID COSI' OF CC1V:�'i.�tt T10H.UIY
tCen3S.t�0
RER00F FEE 10) "000_4.18.000 $30,00
p a a
FEB 2 4 2004
CITY OF LA QUINTA
FINANCE DEPT.
SUB -TOTAL. COI+IMULM, 0Bt AND FLAK CRECK
$30.00
LESS PRE -PAID FTs ;)
$000
'FMALMIlUCiCP"Is' S.1)11F:.N0NV
W
V
RECEIPT
DATE
r
BY__`
ATE INALED`/
I� �"
INSPE R
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
BLOCMALL 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:
3 Q �/v
BUNDE ROOFING & ASSOCIATES, INC.
31-435 Via Las Palmas • Thousand Palms • CA • 92276
(760) 343-7555 • FAX (760) 343-7554
Curtis Sadler � -e 11 �
51-860 Avineda Cortez
La Quintal CA 92253
RE: Re -roof
FOR THE SUM OF: $6,935.00
Note: price includes removal and reinstallation of existing A/C unit
We propose to furnish and apply the following labor and material:
Tear off existing roof and haul away. Over existing sheathing install new 4"x 8" x 3/8" O. S.B.
sheathing (Note: remove existing sheathing over front porch, install new %" A. CX plywood and
3/8" O.S.B.). Re -roof as per BU -N -A -G -3-A specification, which consists of one layer #28 lb. base
sheet nailed to secure. Over base apply two layers #11 plysheet individually mopped with hot asphalt.
On top of new membrane, install new metal trim primed on both sides and set in plastic cement. Seal
top of metal with two layers of #11 plysheet, and hot asphalt. Seal all corners at turn up with Irish flax
felt saturated with hot asphalt. In all angles, install one layer of #72 fiberglass cap sheets, back
mopped and set in hot asphalt. Flood coat entire watertight membrane with hot asphalt and apply
roofing granite at a rate of approximately 350 — 400 pounds per 100 square feet of roof area. Haul
away all debris caused from above work and leave area clean. This estimate includes no extras. Any
questions regarding this estimate please feel free. to call. A 5 -year guarantee will be in effect upon
payment in full.
TERMS: 100% UPON COMPLETION, UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE.
'I THIS ESTIMATE IS GOOD FOR 15 DAYS FROM DATE BELOW.
IT IS HEREBY AGREED BY BUNDE ROOFING & ASSOCIATES, INC. AND THE OWNER THAT WE
THE CONTRACTOR SHALL NOT BE LIABLE FOR ANY OF THE FOLLOWING: DIRT, ROCK, OR ANY
DEBRIS THAT MAY FALL BETWEEN THE SHEATHING BOARDS ONTO LIVING AREAS.
DAMAGES TO ANY CEILING MOUNTED FIXTURES, VENTS AND OR CONDUIT PIPES,
STRUCTURAL DEFECTS IN BUILDING. IT WILL BE OWNER'S RESPONSIBILITY TO REMOVE AND
REPLACE ANY ROOF MOUNTED ANTENNAS AND/OR SOLAR PANELS.
IF THE SERVICES OF ANY ATTORNEY MUST BE EMPLOYED TO ENFORCE COLLECTION THE
OWNER AGREES TO PAY ANY ATTORNEY AND/OR COURT COSTS.
CONTRACTOR'S ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE
CONTRACTOR'S STATE LICENSE BOARD.
1020 N STREET, SACRAMENTO, CA 95814
LICENSE 691270
Respectfully submitted by: /C a7� 4964"Iel—e Date: February, 22, 2004
Accepted By: