0211-068 (RR)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
iSl�4J3
c -t �-
C31���
Signature of Contractor�.�
OWNER -BUILDER DECLARATION
.9/30103
I hereby affirm under penajty 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). 't
() I am exempt under lection B&P.C. for this reason
Date /nSignature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm undernalty of perjury one of the following declarations:
() I have and, m� ain a certificate of consent to self -insure for workers'
compensation, a- prov fled for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
('/j 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 FUMD Policy No. 20.02-00201
(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 shall forthwith comply with those provisions.
Date: t4 t *4o? .'Applicant, -114 —
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)"'Date
-�
BUILDING PERMIT PERMIT#
0211 JAM
DATEVALUATION LOT TRACT
JOB SITE
ADDRESS fVJ_,n1 �t'NTfl)A 11RIASCO
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Jx�.yC� Si1� :TF'LAfit.
P,ZA.NP, RO OF ta010.. " Y
54.421AV' WWAVWASCO
P10, D,M 169
LA CA 92253
YUCCA VAJIZY CA 422W
(760)3365-3100 Muf 3153
USE OF PERMIT
C3F�NMAL �Jii,T3 1t3
PARTd.AL. IZY.-RO CYWITH 30 MR U1'biOL
4j
V'AIi7AT10N 5,3$ xp I's
EMMIM �."O € F CC7�F&'!'KTTCCS 017
.5,,38gt1V
• � ��
E SUMMARY
REROOF ME 101�n0i�0��X 18�f1t5t3 11"A
'[CiTyOFL�.QUINTA
FINANDEPT.
i
OLii3-'I -TOTAL CSSkY tTC'li{3�St AND MAN C 1F >.
V0.00
1X33 MR'S-PAII MMI
$O.W
TOTAL FEWU FUN DITE NOW
$30M
RECEIPT
Df TE }
BY t
DATE FINALE /`
INSPE T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck —
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perri)
COMMENTS:
,00 Alpine
Roof Co.
Lic. # 761151
P.O. Box 167
Yucca Valley, CA 92286
365-3100 Toll Free 1-877-302-3100
PROPOSAL AND CONTRACT
Date //— 5-'—a Z. , 1111
TO V 1r5;n:cl �DE'cc,r
0
-72-z S_S Telephone6
Dear Sir
41wdRaq proposes to furnish all materials and perform all labor necessary to complete the following:
TeUI [� c+ �� L�7"�i'���fnc-r�r�'1 F LIj ✓let �6 nyj J/ -NIS 1/ �v xr,
i ll S,�i i^.'�C1 �.� '7 V� %:U :vr� v•telc { wU �a+Viers' /,�%6s_ �...�(rr /tet Yi�w, /l/e��.. c/�-,OP+_c{[P
/D;Ae �uc rvi�l / Y./rcy�e(e
T �
'lee? an /"101-- '�' +NO;%:feria s sills a
All of the above work to be completed in a substantial and workmanlike manner according to standard practices for the
sum of �', �. c+� •, f 7�/ �4 �f F6,, -/>4y Dollars ($ S,3 5�6 — )
Payments to be made
as the work progresses to the value of
per cent_ %) of all work completed. The entire amount of contract to be paid within
days after completion.
Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon
written orders for same, and will become an extra charge over the sum mentioned in this contract.
All agreements must be made in writing.
FAILURE BY CONTRACTOR WITHOUT LAWFUL
EXCUSE TO SUBSTANTIALLY COMMENCE WORK
WITHIN TWENTY (20) DAYS FROM THE APPROXIMATE
DATE SPECIFIED IN THIS PROPOSAL AND CONTRACT
WHEN WORK WILL BEGIN IS A VIOLATION OF THE
CONTRACTORS LICENSE LAW.
NOTICE TO OWNER OR TENANT: You have the right to require
Contractor to have a performance and payment bond.
ACCEPTANCE
Respectfully sy-bix0ted
By
r ✓UG' -6--;r--do �
Contractors are required by law to be licensed
and regulated by the Contractors' State License
Board. Any questions concerning a contractor
may be referred to the registrar of the board whose
address is:
Contractors' State License Board
1020 N. Street
Sacramento, California 95814
You are hereby authorized to furnish all materials and labor required to complete the work mentioned
in the above proposal, for which agree to pay the amount mentioned in said proposal, and
according to the terms thereof.
ACCEPTED
19
Date J�} 10 ��_