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0211-036 (RR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penglty,of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of ,fhp Business and Professionals Code, and my License is in full force and effect. License # ry .,.,. �. Lic. Class. ExpDate t FS 0153 ( �."."s��i'fiq ( 67131/2t Date�� f ^ Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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 coristruct.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. AY�' 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 STATF 1;���� Policy No. 161541&92 (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'CalI ornia, and agreehthat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code I`shall forthwith comply'with those provisions. ate: n \ L, Applicant Warning: Failure to secure Workers' Compensation coverage "Is -unlawful and shall subject an employer to criminal penalties and'civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application.is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply witl�all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the,above-mentioned property forNtspection purposes. 1 Signature (Owner/AgNe t) � Da BUILDING PERMIT PERMIT## - ,' DATE VALUATION LOT TRACT JOB SITE ADDRESS H)A VW,,A,4,nVO APN T13- 254,0= OWNER' .' CONTRACTOR/DESIGNER/EN INEER DOW -11 VA RB ANW10M!I. i3OC.)1' 7 I d�, rW17 AL IT WCC , 52..-)W? ,Et>!''M.;WNV.MAB1::'0 PO 1Kr07% 11257 LA �;St+(CA. CA 922520. N"L,itil D r: k 92255 ('760)200.081.1 CB 1420 USE OF PERMIT R.&ROODS'W'I 'H I.,If 1ITWI:I0H'r TILE Pt's K'BO 9301CLASS.A MATERIALS (XVT ESIM aaM 0,019-:' OF CdrNttT!RUCrTIOI`a :PERM ,$"!.1t u,, f;(T~, Y 1x1 -ROOF IVE , 101.000-419.000 S;sa.W Nov u 6 Booz U CITY OF LA QUINTA a FINANCE DEFT - +UJceA� SITE "iAL Pn�TM7pp;y/L ChTC. T30.00 0 'I'MAL PFURN 1'T°FEES DUE .[ANY r' RECEIPT DATE ! r� '7 BYV DA .E INAL!P- 72_S INSPEC .f I' YJ �� J �..::.,..� 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 & 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: i', "r• i CONTRACTORS STATE LICENSE # 810537_ ` * f �� y ' Y P.O. BOX 11257 PALM DESERT CA 92255 PHONE.760-200-0811. FAX,760-20010801 c A proposal submitted 1d: DORI L S' VANBLAIRCOM . < , Mailing Address: 52-703 AVE. VALASCO LA QUINTA,'CA 92253 Job,Address: SAMEASABOVE. r ' Phone: 76O-77- Description of Work'to Be Performed: OBTAIN ALL REQIJMD CITY.PERMITS. PITCHED AREA- '-- . S . • ' ` . / .� . REMOVE EXISTING TAR AND GRAVEL ROOF & DISPOSE.. , NAIL ONE LAYER 40# TILE LINER ON CLEAN SURFACE. j 's ' INSTALL NEW ROOF JACKS, (GALVIN= AND ALUnvf[Jnvl) . ' • . INSTALL ALL ROOF TO WALL SHEET METAL. INSTALL LIGHT WIEGHT ROOF TILE TO MANUFACTURES SPECIFICATIONS FIAT ARRA- NAIL ONE LAYER GLASS BASE '4 ` + • I �. ( HOT MOP TWO LAYERS GLASS PLY FOLLOWED BY NEW pERIMETFR METAL z " f INSTALL ONE LAYER 72# CAP HOT MOPPED. PAINT ROOF, JACK TO MATCH ROOF. i CLEAN. JOB SITE TO OWNERS STANDARDS. IF NOT ACCEPTED IN 30 DAYS THIS PROPOSAL IS NULL AND VOID Notes: 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 , •oto any cause beyond our control, including, but not limited to: fiie, lightning, windstorm, hailstorm, antennas or other equipment, foot traffic on roof, structural fault or settlement,. cracking or other failure of the roof deck, walls , or foundation 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, cOo4nj or heating appliances or;,lother equipment, whether or ,l not an additional charge is made for such work, the customer understands that neither Roof Tile Specialty nor the installer, assumes any responsibility for the performance. of.said equipment r 3. Roof Tile Specialty does not asslune any responsibility for corrections of existmg code violations or for the repair, of any existing defects unless ' specified iri estimate and proposal: J , f . $ 830 00 T'erms aid p , •. c Total Cosr %� on completion unless otherwise specified in the contract. If not acceptance in thirty days this proposal is'invalid, -Extra $35.00 per sheet of plywood if needed. i Acceptance:.You are hereby authorized to furnish all contents written in the contract to complete work mentioned in the proposal- contract for which Uwe agree to pay, the amount mentioned., in said proposal, and according to ti ,,. . terms thereof, ;Jv,` . (Initial), If a leakage, caused by defects in workmanship; occurs within TEN ,years ' . 'from date of application, we will repair it free''of charge. ^' Installation: it is understood that by the acceptance of this.proposal you authorize Roof .Tile Specialty to make the - installation; to, issue work order with specifications shown herein and to pay our charge for such installation."• You . { • agree to pay the amount the 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 Roof Tile Specialty. 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 I by this proposal, but shall be provided for under separate and additional order from you. ` ( Initial'). , Arbitration of dis`p'utes: Any controversy or claim arising out of or relating to this contract, or the breach thereof,' shall be settled by arbitrator in accordance with the applicable Construction Industry Arbitrator Rules of the American Arbitration Association which are ]m effect of the time the demand for arbitration is filed. A judgement upon the award rendered by the arbitrator(s) may be entered in court having jurisdiction thereof. Any arbitration ^; award shall be subject to correction and/or vacation for the reasons stated in the'code•of civil Procedure. The ` arbitration shall award reasonable attorneys fees and expenses to the prevailing party. After being given due notice, should any party fail to appear at or participate in the arbitrator proceedings, the arbitrator shall make an award based upon the evidence presented by the paity(ies),who do (does) appear and participate. Notwithstanding • Contractor's right to arbitrate,' contractor does not waive anv of item IiAn'r;;,ht. T., a;