0310-248 (BLDG)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 C:odP. and my I iranse is in fill[ force and offoot.
License # Lic. Class Exp. Date
.a ;f. ,r 07 C39 ARB 8l 1/04
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:
( ) 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.
A,/ I have and will maintain workers' compensation insurance, as required by
SQCtion 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 ajI! ss.3ri)N).a Policy No. (ti±rt>:'.4-Q3
(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.'N /
Date: P.•T..;.. ApplicantA
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 application 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) / a Date B(--Z7,-,:v3
.04,.% 4:
BUILDING�RERMIT PERMIT#. �•
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DATE VALUATIONLOT TRACT
JOB SITE APN
ADDRESS 's7-2ff..5 C;A,7.4-T aSOnO -
OWNER CONTRACTOR / DESIGNER / EN 5NEER
17••205 CAUX 30114011A G8••:t 14 XC1;..UAY .'sZ.
4
CA 2231Com'! TI �t::C:7ZAI(f:': r y, CA 9 234
USE OF PERMIT
01 NERAL BUMMING
l;:L+•itG}ta?" £�11`t� 1.3'�.'i!'�' •J�7�:{C7Hi' �'3t.�•
VA:) UA`.!'I":.-M 3,3 0 t} !.,0
FSMIA'a. ) cosr OF CCzPS'i'RUC.'•'TION
i' ET I,uf VXX G'i1NUklESRY
H-ROOP TZ ' 101-00, 418.000 $10.00
.UJ ,1100 At+b1:91�1:.AAl'CHECK—
S 2 21�p L B 1°A�-�'P.D:, 1"ET:FK"WIT ME IS' DUN 14 OVI T1.30A1
IL
RECEIPT I DATE BY ! ; y'. f I /DATF FINALC � � LINSPEC��
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I 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
,-ewer Connection
Encapsulation
Gas Piping
4as Test
Appliances
Final
COMMENTS: .
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)
THE R EROOFINC SPECIALISTS INC.
ROOF/RSG
Corporate Office: Desert Office:
2626 Newport Blvd. 68-314 Kieley Road
Costa Mesa, CA 92627 Cathedral City, CA 92234
949.548.1645 /Fax: 949.548-2617 License #460707 760.324.5482 / Fax: 760.328.4612
PETRONELLA ROOFING hereinafter called "Contractor' and/or "Seller" agrees to provide the following listed labor materials and construction:
NAME / OWNER: Paul Luna
REROOF PROJECT ADDRESS: 77-205 Calle Sonora
CITY, STATE & ZIP CODE: La Quinta Ca, 92253
BILLING ADDRESS:
CITY, STATE & ZIP CODE:
PHONE NO.: (760) 771-2274
ADDITIONAL PHONE NUMBER: FAX NUMBER:
DESCRIPTION OF LABOR MATERIALS AND MISC.:
Petronella Roofing will furnish all labor and materials for recoating as per proposal dated November 13, 2002.
Eaglelite Lifetime Limited Material Warranty
TOTAL COST FOR CLAYLITE OR EAGLELITE REROOF....................................$8,320.00
'SPECIAL INSTRUCTIONS:
SCHEDULE OF EXTRAS
1. Remove and replace any damaged or deteriorated plywood at $2.00 per sq. ft.
2. Any electrical or plumbing work will be charged $67.50 per man per hour and
materials plus 10%.
CONTRACT TERMS:
1/3 Deposit: $ 2,774.00
1/3 Progress:$ 2,773.00
1/3 Final: $ 2,773.00'
TIME FOR STARTING AND COMPLETING PROJECT: Work Shall commence within ten (10) days from the date of sale unless specified otherwise
and be substantially completed in approximately ten (10) working days with additional time to be as detailed in Paragraph 9. of the
Terms, conditions and "Notice to Owner" on the back hereof Substantial Commencement of work shall be defined as the installation of any materials and/or labor.
C ontrnntnrc failure to cnhctaniially nnmm(-.nne wnrk withnnt lawful esnuce within twenty QO) rinvc frnm the Ante cnenifierl ahnve. is n vinlatinn of the C..nntrantnrc