0203-428 (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
Date 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:
J)VuI, 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
L ,
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 is1sued.'My workers' compensation insurance carrier & policy no. are:
Carrier t� Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
V), 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 37.00 of the Labor
erode, I shall forthwith; comply with those provisions.
Date: :Applicant -''
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety ,
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes,_,y,_---"
Signature (Owner/Agent) Date
- _BUILDING PERMIT PE
MIT#
DATE VALUATION LOT t
ar2Q3^42'8 TRACT.
JOB.$I
AD' Rr�
APN
o ��r "40 AV.�I�a}.itA VELASCO
`
- -
OWNER Y
CONTRACTOR / DESIGNER / EN (NEER
PAIAkEBIJA
i3i�Vrl t C4I7it 7.� L
54.640 A:OMA1l1'sLASC O
LA Q=rA CA 92253
-USE OF PERMIT _
OF—, ERAL BtT,TY ANG
REPAIR OF ROOF AND SUPPOWr MW'EEN MAW HOUSE AND SOLIT11
CiARAM
VA LIJA'! IO14 30D.00 LS
RUMAM COS` OF COi4 s IR11'C'1lt7m
"Woo
PERMIT.k".n &i3.MMARY
K" CHECK FFM 101.000-439.31U i9,7i
CONSTRUCTION FEE 1131-000-418-000 $15.00
MONO MOTION FRE - REMD 1011 -000 -MI -000 $130
'i
SUB -TOTAL C;C,31ar�r�CUCTION .AW.11+J. 49' Cz�3:1'.CK
_
s _ LAW .PRX. -PIAM 1 .:
S DUE NOW
MAR 29 2002
CfTYORA QUU&TA
RECEIPT
DATE ^"
BY
DATE FINALED
INSP
C
- Q
!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 A
Combustion Air
Roof Deck •O
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 /-/,� 43
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
r
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
COMMENTS:
Final s
U ility 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)
Bin #
City of LaQ [rota
Building S Safety Division
P.O. Box 1504, 78.495 Calle Tampico
!a Quinta, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
Permrc M
Project Address: C L-LDAj C Ij I �
Owncr's Namc: t77
A. P. Number:
Legal Description:
Contractor. �( ` 0 ti S f�QOVt,7,
Address: X — ^C{D UEN C IUL-�A.c.
Cite. ST. Zip: KLnu U 5
Tin
Telephone:
Address: �- — L0 S u fVlist IF b A—
Project Descnptton: X
Cite. ST. Zip: E
Telephone: X� (a 1 1 L
�� C
i __ k)STA (C,
State Lic. t:: )L `� _ L
Cite Lic. r
Arch.. Engr.. Designer:
Address:
.Cit,. ST. Zip:
Telephone:
State Lic. tl:
Construction Type: Occupancy:
Project type (circle one)- Ne%% Add"n Alter Repair Dema
Name of Contact Person: x ., p ji wt (;Aft
Sq. Ft.:--F
-stories:
- Units
Telephone = of Contact Person: X
31)61f "' 1 Estimated Value of Protect: x O ®(N -o a O
APPLICANT: DO NOT WRITE BELOW THIS LINE
a
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Z/L$
Item
Amount
Structural Calcs.
Reviewed. ready for corrections
2
Plan Check Depose
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cities.
Plans picked up
�f'D?�
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
:" Review. ready for correctionsiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S I 1
N.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
A I P P
IN HOUSE:-
'" Review, ready for corrections/issue
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
.C)
IN
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name. 1-1
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or, more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer•and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is' providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing 'their own' work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF IA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quints,CA 92253
(760) 777-7
FAK (760
3�-
O ER' N E / DATE
S -1-f6 q0 "C V CL6;
PROPERTY ADDRESS
PERMIT NUMBER(s)
s,
I ; A
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
'APPROVED
FOR CONSTRUCT ON
DATE I'l 0
FOR
CT ON
crff t6e
ter
AL MILLER AND SONS ROOFING CO., INC.
"BETTER ROOFS FOR BETTER LIVING,
68-760 SUMMIT DRIVE, CATHEDRAL CITY, CA 92234
PH. (760) 346-1214 FAX. (760) 321-7097
LICENSE # 336547
PROPOSAL AND CONTRACT
Owner: Brian Burr Project: Tile Roof Reinstallation
Address:54-640 Avenida Velasco Address: 54-640 Avenida Velasco
City: La Quinta, CA 92253 City: La Quinta, CA 92253
Phone: 564-3336
WE PROPOSE TO FURNISH THE FOLLOWING MATERIALS AND PERFORM ALL LABOR TO ROOF THE ABOVE LOCATION.
Pitch Roof Roofer to remove existing tile from main house front garage and dead valley area
between main house and rear garage. Roofer will then re -sheet the same with OSB plywood install'
per UBC and taper dead valleypositive roof drainage Roofing contractor will then reinstall roof
tile per manufactures recommendations over one (1) laver ASTM base sheet nailed to roof deck
Roofer to reinstall roof jacks edge metal Z bar, tile pan and roof to wall metal Roofer to replace
any broken tile with same profile, and color to match as close as nocciw_e
Taper cricket area: Roofing contractor will install a class "A" built up roof system using the following
materials One (1) laver Glass Base mechanically fastened to wood deck Two (2) layer glasply type IV
(4) hot mopped with 25 lb asphalt between layers with white #72 glass capsheet installed in a solid
mop of 25 lb. asphalt. Price includes new unpainted edge metal roof permits and taxes
Roof Price: $ 10,000.00
Exclusions: Rear Garage Addition
Terms: Net Cash on Completion
ATTENTION
Section 7018 of the Contractors License Law provides that starting July 1, 1966, everyone licensed by the Contractor's License Board shall
give a copy of the following notice to the payor prior to receiving from the owner of the property or his agent any payment for work which a
contractor's license is required
NOTICE
"Under the mechanics' Lien Law , any subcontractor, laborer, supplier or other person who helps to improve your property but is not paid for
there work or supplies, has a right to enforce a claim against your property. This means that, after a court hearing, your property could be sold
by a court officer for the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid your own contractor in
full, if the subcontractor, laborer, or supplier remained unpaid."
Al Miller & Sons'Roofing Co., Inc. Agrees to furnish its regular form GUARANTEE for 2 Years after completion of its said work. Said
guarantee to cover defects in material and workmanship only and not to extend to damage to roofing caused by the elements, other unusual
Acts of God and shall not cover any liability for damage to interiors fixtures, decorations, walls, contents of building or other parts of structure
not to damage of faulty construction. It is also understood and agreed that the above guarantee shall be made and remain only when and if
payment is made as agreed in this contract. Al Miller & Sons is not responsible for TV antennas .
We are fully covered by Workmen's compensation and public liability insurance. Carriers' names and policy numbers are available on request.
Any alterations or deviations 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 sum mentioned in this proposal. All agreements must be made in writing. This offer is valid for
one week from the date of estimate and is based on free access to building for direct loading from our truck.
Prices are based on current cost of material and labor, increases or decreases will be reflected at time of signing of contract. Al Miller & Sons
is not responsible for any damage to sidewalks, curbs or driveways. If there is any conflict between this proposal, and any other contract or
specification relating to the above referenced project the terms of this proposal shall prevail.
Respectfully
Accepted:
SONS ROOFING., INC.
John Lamons, Estimator
Date: 04te: 01-21-02