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11-0540 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000540 Property Address: 53530 AVENIDA VALLEJO APN: 774-123-001=24 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 30000 Applicant: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153. BUILDING PERMIT Date: 7/06/11 Owner: MCLAREN ROSEANNE/HUNTLEY RON 60 HIGH OAK DR MEDFORD, OR 97504 - ------=------------------------------------- - - - - -- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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 Class: License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that.he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a y pplicant fora permit subjects the applicant toga civil penalty of not more than five hundred dollars ($500).: 1 ) 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the , improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of . property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). - 1 _1 I am exempt under Sec. 134P.C. for this reason ner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the . work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: IfN� Lender's Address: LQPERMIT Contractor: Owner FF ' �I --------------------------------------7--------- WORKER'S COMPENSATION DECLARATION ' 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 3706 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: ,. Carrier Policy Number 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 00 of the Labor Code/, IIsshall lfforthwith comply with os provisions., /te: � A icant: WARNING: FAIL RE E�ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this court 7 enter upon the • ve-mentioned property fore cc-titon� purposes ,da� ♦ �/ Sig ure (Applicant or Agent): Application Number* 11-00000540 ------ Structure Information ROOF REMODEL AND LATERAL BRACING REHAB ----- Other struct info . . . . . CODE EDITION 2010 .Permit . . . BUILDING PERMIT Additional desc . Permit Fee 284.50 Plan Check Fee 184.93 Issue Date Valuation 30000 Expiration Date 1/02/12 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 THOU BLDG 25;001-50,000 32.50 Special Notes and Comments REMOVE AND REPLACE EXISTING CUT AND STACKED ROOF FRAMING WITH TRUSSES, INCLUDING REHABILITATING EXISTING - LATERAL BRACING FOR ADDITIONAL SIESMIC AND WIND LOADS (ENGINEERED] THIS PERMIT DOES NOT INCLUDE MECHANICAL,, ELECTRICAL OR PLUMBING INSTALLATIONS. ADDITIONALLY A SEPARATE PERMIT IS REQUIRED PRIOR TO COVERING ALTERED WALL FRAMING. 2010 CALIFORNIA BUILDING•CODES. • July 5,-20.11 4:16:27 PM 'AORTEGA ------------------------------------ ------- ----------- Other Fees . . . . BLDG,STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 18•.49 STRONG MOTION •(SMI) - RES 3.00 Fee summary Charged Paid Credited Due Permit Fee.Total 284.50 .00 .00 284.50 Plan Check Total 184.93. .00 .00 184.93 Other Fee Total 23.49 .00 .00 23.49 .Grand Total 492.92 .00 .00 492.92 LQPERMIT - .. Bin # City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit G, L1 Project Address: S 3— 5 3 p tI S N I /bOwner's A. P. Number: Name: `V U N s C_ RL Address: Legal Description: City, ST, Zip: Telephone:•:..«,::>::>:ri;:;::>:»:':>.::.«;:<;::»>>?:«:>:: . Contractor:©W N� � Address: (•p p Project Description: City, ST, Zip: 7-5,01 • ^:�::>::;:;.:::<:>:: �:::;::::;�:::::;::;>::>::;::>:::.>::»: Telephone:NA State Lic. # : City Lie. #.: I1 Arch., Engr., Designer: :J-0 CJI , Do e. ST(. . G— G Address: P sox is City, ST, Zip: (A) Telephone: ���:�•»:,.::•;:•::;>�.,.;;;N:::•:t lG ��Q- State Lic. #:}::::<:»::>.><:.>:•:.::<:>::::>:.;:»:>;.;:<.::::::.:;::;•::;:; ""' "'""'"'"''}%<<si<'<?<<:s>>: Construction Type: (� Occupancy.. '—I'r' P Y Project type (circle one): New Add'n Aiter Repair Demo Sq. Ft.: / QO #Stories: #Units: Name of Contact Person: ��� Telephone # of Contact Person: 5e4) —!,53 $ — ZZI Estimated Value of Project: — p o 0 0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted em Amount Structural Calcs. Reviewed, ready for corrections 1061Plan Check Deposit Truss Calcs. p? Called Contact Person 6 4Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmittedt(p Mechanical Grading plan 2°" Review, ready for correctio ssue ' Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person I•p,p Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Q�- 1�5`�- j �,b 5 _• e I- S - ° -�Z Y ♦t M�r%i.' M/1Mi,g ,i/A'`� �1 �A 4yi �, N • :'�11� S x 0� 05/12/2011 01:38. 7603237743 PAGE 01 ° SCOTT MORRISON & ASSOCIATES P.O. Box 55329 31855 Date Palm Drive, Ste. 3007 `Riverside, CA 92517 (909)624-1665 Cathedral City; CA 92234 (760)323-7743 ASBESTOS SURVEY REPORT Completed On May 12, 2011 PLM0510#0701 Client:. George Lambert Construction 6226 E. Evans Creek, Unit 21 Rogue River, OR 97537 Project: 53-530 Avenida Vallejo La Quinta CA On May 10, 2011 an asbestos inspection and bulk sampling was conducted at the above project address location. Bulk samples were taken of all suspect asbestos containing' building materials (ACBM) at the request of the client named above. Bulk samples were submitted to Carolina Environmental, Inc. (upon request) located at: 107 New Edition Court in Cary, NC (NVLAP Code 101768-0 and Cal. Environ. Lab. Cert. #2483) to estimate the percentage of asbestos by volume and determine the type(s) present Carolina Environmental. Inc, determines percentages and type of asbestos by using EPA approved method 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Samples. Bulk samples are analyzed by PLM (Polarized. Light Microscopy). Asbestos is quantified using the visual arena estimation technique and can only determine the approximate percentage of asbestos present After a thorough search is conducted and no asbestos is detected "none detected' will be noted in the report. The essence of polarized light microscopy is not to emphatically determine that no asbestos is present, merely that none was detected or, if it was, k was likely to be less than 1.0% of the sample. When findings reveal less than or close to 1.0% asbestos contained in a sample, further analysis may be called for on additional samples to confirm Or denounce the initial findings. The California Code of Regulations (CCR 1529) requires bulk sampling to be conducted according to the A.H.E.R.A. protocol provisions of 40 CFR Part 763.86. The A.H.E.R.A. protocol recommends three (3) or more friable surfacing samples from a homogenous area be collected and analje`d before any building material is determined to be non -asbestos containing. Scott Morrison 8 Associaiitjs conducts asbestos inspection' surveys following the A.H.E.R.A. inspection protocol ASBESTOS INSPECTION BY: Scott C. Morrison, GOSH # 92-0248 The results on the following page(s) indicate that asbestos (greater than 1.0%) was detected in (01) of the (07) total samples analyzed. (1) 05/12/2011 .01:38 7603237743 PAGE 02 t. SCOTT MORRISON & ASSOCIATES P.O. Box 55329 • 31855 Date Pahn Drive, Ste. 3#507 Riverside, CA 92517 Cathedral City, CA 92234 N (909)624-1665 (760)323-7743 PLM0610#0701 r Sample #GL-1 Type of material: final wall coat/ blue-grey Location: interior S. wall, living room Area: interior walls-1" layer Friable: no Results: none detected Sample #GL-2 Type of material: base coat plaster/ R. tan Location: interior S. wall, living room Area:. interior walls-27tl layer Friable: no Results: none detected Sample #GL-3 Type of material: drywall/ white Location: interior S. wall, living room Area: interior walls-So layer Friable: no Results: none detected Sample #GL4 Type of material: 9" floortile/ tan-black Location: bathrooms (2), under caipet Area: approx. 70 total sq. ft. Friable: no Results: 5% Chrysotile asbestos ` R Sample #GL-5 Type of material: file mastic/ black Location: under sample #GL-4 Area: approx. 70 total sq. ft. Friable: no Results: none detected ,Ip Sample #GL$ Type of material: exterior wall stucco/ white '! Location: exterior E. wall (by pool). Area: exterior walls-1" layer. i Friable: no Results: none detected f Sample #GL-7 Type of material: exterior wall stucco/ orange Location: exterior E. wall (by pool) 11 Area: exterior walls-2ndlayer Friable: no Results: none detected f Note: All asbestos containing building material(s) containing greater than 1.0% asbestos by volume or �! weight, must be removed by a state certified asbestos abatement contractor prior to, any demolition or renovation of the property. All asbestos-containing materials more than 100 sq. ft'must be reported to SCAOMD. Inspector Scott C. Morrison Z Certified Asbestos Consubrit DOSH#92-0248 (2)'�" 4 zo�� Proposal/Contract Lic. # 716538 - D.O.S.H. # 630 www.alliance-enviro.com info@alliance-enviro.com Project: Lambert, George Customer: George Lambert "Property" Address: 53530_ Avenida Villejo Address: 53530 Avenida Villejo City: La Quinta' State: CA Zip: 92248 City: La Quinta State:CA-Zip:92248 Contact: George Lambert Contact.- George Lambert Work No.: 541-535-2213 Phone No.: 541-535-2213 Mobile No.: •Fax No.: 4` Claim/Policy or Job No.: I SCOPE OF.WORK: (DESCRIPTION OF THE PROJECT AND DESCRIPTION OF THE SIGNIFICANT MATERIALS TO BE I� USED AND/OR EQUIPMENT TO BE INSTALLED) ' Notify required local regulatory agency prior to job start. 4 Isolate work areas. Attach two layers of poly sheeting on the walls and floors. Set up the shower decontamination system adjacent to work area(s). Run negative air filtration during the abatement. _ 1! h Monitor air in the work area(s).Remove for disposal viynl floor tile containing asbestos in the affected area of the 2 bathrooms only. Remove and set aside toilets. AEG is not responsible if toilets are damaged while moving. Transport, manifest and dispose of waste at an EPA landfill. Tear down containment upon final inspection. I` NOTE: Alliance is not responsible for the restoration of this property. NOTE: 10% Deposit is required at the start of the job and paid in full upon completion. Customer is responsible for a crew mobilization fee of $250.00 if job is cancelled or rescheduled on the day of start. Reference Section 6 of Agreem Customer will be responsible for any additional hours worked due to time delays in starting the project at a cost of $125 per man per hour. stomer Initial r s v Asbestos - $995.00 TOTAL BID: $996.00 Customer acknowledges and authorizes Alliance to sign the Hazardous Waste Manifest "on behalf of the generator. Customer Initial EXCLUDED: (Any work that is not specifically included in this Scope of Work or otherwise not described shall not be any, part of this Agreement. Failure to list work as specifically excluded does not mean the work is included. Without waiving these provisions, the following work is specifically excluded from this. Agreement and Scope of Work. Any and all generator fees are to paid by generator not by Alliance Environmental Group, Inc.) 't DAMAGE: Damage to walls, wallpaper, wood, and all painted surfaces occur as a result of containment installation. Every attempt will be made to minimize such occurrences. Repairs of such damages are not included in the scope of this proposal. THIS PROPOSAL IS SUBJECT TO CHANGE AND MAY BE WITHDRAWN IF NOT ACCEPTED WITHIN 30 DAYS. IT IS SUBJECT TO AND INCLUDES ALL TERMS AND CONDITIONS LISTED ABOVE. 1 ;.L sr AGREEMENT'+ ., Page 1 of 8 Alliance Environmental Group, Inc. (hereinafter referred to as "Alliance"), and the undersigned homeowner or tenant (hereinafter referred to'as "Customer") agree as follows: 1. SCOPE OF WORK: In consideration of the payment specified below, Alliance is hereby authorized and agrees to furnish all labor,'materials, and equipment necessary to perform removal and disposal of asbestos, lead, mold, and/or other materials and/or to perform hazardous remediation of hazardous materials, all as specified in an agreed, written scope of work (hereinafter referred to as ""Scope of Work"") with Customer or with Customer's insurance company (hereinafter referred to as ""Insurer and attached hereto as Exhibit 1. Alliance shall perform the Scope of Work in material compliance with all applicable federal, state and local regulations. Any deviations from the Scope of Work are solely Customer's responsibility. Alliance agrees to use reasonable best efforts to complete the Scope of Work. However, Customer acknowledges and agrees that this Agreement is fcr Alliance's effort and not for any particular results. ALLIANCE MAKES NO REPRESENTATION OR WARRANTY THAT THE WORK DESCRIBED IN THE SCOPE OF WORK WILL RESULT IN THE ELIMINATION OF HAZARDOUS MATERIALS OR MOLD FROM THE AREAS DESCRIBED IN THE SCOPE OF WORK. ALLIANCE MAKES NO REPRESENTATION OR WARRANTY REGARDING HAZARDOUS MATERIALS OR MOLD IN AREAS, INCLUDING ADJOINING AREAS, NOT SPECIFIED IN THE SCOPE OF WORK, NOR THAT SUCH MATERIALS OR MOLD WILL NOT MIGRATE TO AREAS DESCRIBED IN THE SCOPE OF WORK FOLLOWING COMPLETION OF OR DURING THE SCOPE OF WORK. Without limiting the foregoing, Customer specifically waives and releases Alliance from any claim on account of work recommended by Alliance but not accepted by Customer or Insurer." 2. CONTRACT PRICE: The Contract Price is 995.00,for the Scope of Work, as agreed in writing by Customer or Insurer, and Customer hereby agrees thereto. Down Payment: $ DOWN PAYMENT MAY NOT EXCEED $1,000 OR 10 PERCENT OF THE CONTRACT PRICE, WHICHEVER IS LESS. Customer shall pay Alliance the Down Payment prior to Alliance scheduling work, with the balance due upon completion of work. Interest at the rate of 1.5 (one and one-half) percent per month, or the maximum rate per month allowed by law whichever is less, will be charged on all accounts past due more than thirty (30) days. In the even: of failure to pay any of the amount due in this invoice, all collection costs and/or attorney fees in the collection of any such amourt will be paid by the customer. Notice to Customer: You are entitled to a completely filled copy of this agreement, signed by both you and Alliance, before any work may be started. 3. INSURANCE TRANSACTION: When the agreed Scope of Work is made between Alliance and Insurer, Alliance agrees that iit will complete the work in consideration of payment by Customer of any deductible under the Customer's applicable policy of insurance, and endorsement or direct payment to Alliance of Insurer's payments under Customer's applicable policy of insurance with Customer to be liable therefore in case of non-payment. Notwithstanding the above Customer agrees that Customer is jointy and severally liable to pay Alliance any and all amounts due under the Scope of Work if made between Alliance and Insurer. Customer's signature on this Agreement grants Alliance the Customer's power of attorney to sign or endorse any checks and/or drafts made payable to the Customer for original damages or supplemental claims (supplements), as settlement for Customer's claim for damages to Customer's home. Customer will send all supplement claims directly to Insurer, and agrees that checks from Insurer will be sent directly to Alliance. 4. START DATE AND COMPLETION DATE: California Law requires that Contractor start this project within (20) days subject to Contractor's ability to obtain permits and Customer's ability to obtain financing if Customer is buying the property in question. Customer is advised that processing and obtaining permits may require an additional 10 working days from signed contract. The agreed Start Date and Completion Date for the Scope of Work are as follow: ESTIMATED START DATE: 5/16/11 ESTIMATED COMPLETION DATE: 5�� b �ll 5. SITE ACCESS: Customer agrees to ensure that prior to any work undertaken by Alliance, the site of the work, the area from which the work is controlled, and any storage area used by Alliance in connection with the work (collectively referred to hereinafter as the "Site"), shall be vacated and remain closed to all persons (other than ALLIANCE employees) for the duration of the projec-. In the event that any individual other than ALLIANCE employees enters the Site, Customer agrees that ALLIANCE shall not be held liable for any claims, including, without limitation, any claims relative to asbestos, lead, mold and/or hazardous remediation exposure arising there from, and including, without limitation, any claims of negligence by ALLIANCE; and that Customer will indemnify and hold harmless ALLIANCE from all such claims, including costs of defense. 6. SCHEDULE CHANGES AND CANCELLATIONS: Schedule changes must be made no later then 24 hours in advance of jot start. Customer agrees to pay a reasonable administrative charge in the event of a cancellation, other than cancellation done prior to the third business day after the date of this Agreement. Page 2 of 8 7. EXTRA WORK AND CHANGE ORDERS: Customer and Alliance, or Insurer and Alliance, may change the Scope of Work at any tiri a acid from time to time, including changes in scope, methods, scheduling or performance requirement, but no such change shall be effdctive unless and until an agreed written Change Order is made and executed, including appropriate adjustments to the overall price and completion date of the Scope of Work. Subject to the following, if Alliance undertakes additional or different work notwithstanding the absence of a Change Order, it will not operate as a waiver of this provision, and Alliance will nevertheless be entitled to appropriate equitable adjustments to the price and completion date terms of the Scope of Work. All phone quotes are subject to field verification. Extra Work and Change Orders become part of the contract once the order is prepared in writing and signed by the parties. The order must describe the scope of the extra or change, the cost to be added or subtracted from the contract, and the effect the order will have on the schedule of progress payments, if any. Change Orders required by the building department at the jobsite shall be considered incorporated into the contract without being signed by both parties." 8. SUPPLIED PROPERTY: Whenever the Customer, its employees, contractors, and subcontractors (other than Alliance), use ladders, scaffolding, tools, vehicles, equipment or property of any kind either owned or rented by ALLIANCE, Customer shall indemnify and hold ALLIANCE harmless from any and all claims, demands, damages, causes of action and suits of whatsoever nature and kind, arising out of, or connected with the use of, such ladders, scaffolding, tools, vehicles, equipment or property, except when caused by the sole active and gross negligence of Alliance. 9. DIFFERING SITE CONDITIONS: If ALLIANCE encounters subsurface, latent, unusual or unknown physical conditions at the Site differing materially from those indicated in the bid documents, ALLIANCE will promptly notify Customer or Insurer. If such conditions cause an increase or decrease in the cost of, or the time required for, performance of any part of the Scope of Work, any appropriate equitable adjustments in price and completion date shall be made and the Scope of Work modified accordingly. As above, all phone quotes are subject to field verification. 10. HAZARDOUS WASTE DISPOSAL: Unless otherwise agreed, ALLIANCE is authorized to sign the Uniform Hazardous Waste Manifest on behalf of the owner. 11. INCIDENTAL DAMAGE: Customer acknowledges that damage to walls, wallpaper, wood, and all painted surfaces occurs as a result of containment installation. Every attempt will be made to keep such occurrence to a minimum. Repairs of such damage are not included in the Scope of Work nor are they Alliance's responsibility. 12. INDEMNITY AND DISCLAIMER OF RESPONSIBILITY: Alliance disclaims any and all responsibility for any other contractors, including those who may be deemed subcontractors; if Alliance engages any other contractors or subcontractors to perform any part of the Scope of Work, Alliance does so in an agency capacity on Customer's behalf and for Customer's account, and Customer hereby authorizes Alliance to do so. Customer agrees to indemnify Alliance, its officers, directors, shareholders, owners, managers and employees for any damages or claims, including costs of defense, from any other contractor or subcontractor arising from or related to the project described in the Scope of Work. 13. EXISTING AND ONGOING CONDITIONS: Customer acknowledges that it has incurred and sustained, and will continue to incur and sustain, costs, expenses, losses and damages arising out of, relating or resulting from asbestos, lead, mold, and /or other hazardous materials contamination (""Mold/Hazards Contamination"") at the Property until such time as said Mold/Hazards Contamination is remediated (Mold/Hazards Damages""). Customer further acknowledges that Alliance neither caused the Mold/Hazards Contamination of Mold/Hazards Damages nor caused the existing and ongoing conditions that caused the Mold/Hazards Damages including but not limited to moisture intrusion due to rain, leaking pipes or other sources (""Conditions""). In addition, Customer acknowledges that it may incur further and additional Mold/Hazards Damages due to presence of Conditions that Alliance did not cause, for which Alliance is not responsible, and that are beyond Alliance's control. In consideration for the foregoing acknowledgements, Customer agrees that Alliance is not responsible or liable for Mold/Hazards Damages, and Customer agrees to release Alliance from any claim arising out of, connected with or related to Mold/Hazards Damages." 14. RECURRENCE OF MOLD/HAZARDS CONTAMINATION: Alliance does not warrant or represent that surface or airborne Mold/Hazards Contamination will not recur or recontaminate the Property after Alliance performs the Services. Customer acknowledges that it is and shall remain responsible for, and that Alliance shall not be responsible or liable for, the correction, repair or removal of Conditions on and at the Property that may, in whole or in part, cause or contribute to Mold/Hazards Contamination. Customer further acknowledges that Alliance shall not assume any responsibility or liability for protecting the Property or any of its contents from water or moisture intrusion due to rain, leaking pipes or other sources of moisture. Accordingly, Customer acknowledges that Alliance is not responsible or liable for any loss or damage to wall coverings, paint or substrate surfaces, such as drywall, plaster or wood, caused by or related to the procedures that Alliance employs to perform the Services including but not limited to taping plastic barriers to walls. This paragraph shall survive the termination or other expiration of this Agreement. Page 3 of 8 15. ELIMINATION OF CONDITIONS: Customer acknowledges that it, and not Alliance, is responsible for the elimination of any and all Corlditions from the Property that may cause or contribute to re -contamination by Mold or other Irritants, including but not limited to standing water, faulty plumbing, leaks, dampness from condensation, damaged wood, roof leaks, direct wood to soil contact, improperly protected exterior wood surfaces, landscaping above foundation grade line, and improperly installed irrigation. This paragraph shall survive the termination or other expiration of this Agreement. 16. RELEASE OF ALLIANCE: Customer, on behalf of himself/herself/itself and his/her/its officers, directors, shareholders, heirs, executors, successors, administrators, representatives, assigns, tenants, invitees, guests, or any party (including minor children) for which Customer may be legally responsible (collectively hereafter ""Releasors""), does hereby fully and finally release and forever discharge Alliance and its officers, directors, shareholders, employees, successors, assigns, agents and representatives (collectively hereafter ""Releasees"") from all past, present or future liability, damage, losses, claims or expenses, of whatever nature including but not limited to claims for death, bodily injury, ill health or property damage, whatever foreseen, attributable to Mold/Hazards Contamination, Conditions, the pre-existing presence or continuing presence of surface and//or Mold or other Irritant conditions on, in, about or within the Property. Releasors shall indemnify, defend and hold Releasees free and harmless from all such liability, damages, losses, claims or expenses (including reasonable attorney's fees and costs in the event of litigation), whether asserted by Releasors or any third party. This release and indemnity shall be provided by Releasors even if Releasees are partly responsible for the claim, damage, injury or loss, but Releasors shall not provide indemnity for claims or losses caused by the sole negligence or willful misconduct of Releasees. This paragraph shall survive the termination or other expiration of this Agreement." 17. UTILITIES; STORAGE: Customer agrees to provide to Alliance, free of charge, reasonable use of electrical power, light, water, and storage space necessary for the proper undertaking and completion of the Services at the Property. 18. LIMITATION OF DAMAGES: The maximum amount for which Alliance may be held liable to Customer for any of Customer's actual, incidental or consequential damages of any type whatsoever, is the total amount payable by Customer to Alliance for Services performed pursuant to this Agreement. The parties agree that such liquidated amount of damages is a reasonable estimate of actual damages, which are otherwise difficult or impossible to calculate. This paragraph shall survive the termination or other expiration of this Agreement. 19. FORCE MAJEURE: ALLIANCE shall not be deemed to default nor be liable for damages for any failure or delay in performance of its work which arise out of causes beyond its reasonable control. Such causes may include, without limitation, acts of God, acts of terrorists or terrorist organizations, the public enemy, acts of government in either its sovereign or contractual capacity, fires, floods, earthquakes, epidemics, quarantine restrictions, strikes, freight embargoes, material shortages, or unusual severe weather. In the event work by Alliance is delayed by such causes, the completion date will be extended accordingly. 20. INTEGRATION: This Agreement is the final, complete and integrated expression of the parties' agreement and sets forth all terms and conditions upon which ALLIANCE will complete the scope of work described above, and may not be varied unless in a writing signed by the party to be charged. 21. ARBITRATION OF DISPUTES: The parties agree to resolve any dispute arising out of this Agreement through binding arbitration, with no right of appeal, before a single arbitrator before the Judicial Arbitration and Mediation Services (JAMS) in Los Angeles, San Diego, San Francisco, or Ventura, California, as the parties may agree, and the costs of which shall be borne equally by the parties subject to subsequent apportionment by the arbitrator. This paragraph shall be specifically enforceable under prevailing arbitration law. The prevailing party shall be entitled to reasonable attorney fees. The claimed or actual necessity or advisability of the presence of a third party not subject to arbitration shall not operate to defeat this arbitration clause, but so much of the dispute as may be resolved between the immediate parties hereto shall be arbitrated hereunder. NOTICE: BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTE ARISING OUT OF THE MATTERS INCLUDED IN THE'ARBITRATION OF DISPUTES' PROVISION DECIDED BY NEUTRAL ARBITRATION AS PROVIDED BY CALIFORNIA LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSES TO HAVE THE DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW YOU ARE GIVING UP YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL, UNLESS THOSE RIGHTS ARE SPECIFICALLY INCLUDED IN THE'ARBITRATION OF DISPUTES' PROVISION. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER AGREEING TO THIS PROVISION, YOU MAY BE COMPELLED TO ARBITRATE UNDER THE AUTHORITY OF THE BUSINESS AND PROFESSIONS CODE OR OTHER APPLICABLE LAWS. YOUR AGREEMENT TO THIS ARBITRATION PROVISION IS VOLUNTARY. WE HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THE'ARBITRATION OF DISPUTES' PROVISION TO NEUTRAL ARBITRATION. Customer: Assent Non -Assent Alliance: Assent Non -Assent 22. COMMERCIAL GENERAL LIABILITY INSURANCE (CGL): Alliance carries commercial general liability insurance written by Commerce & Industry Ins. Co. You may call the insurance company at (949) 851-8800 to check Alliance's coverage. 23. WORKERS' COMPENSATION INSURANCE: Alliance carries workers' compensation insurance for all employees. Page 4 of 8 .z NOTICE �TO OWNER' ':,, � _ � MECHANICS' LIEN WARNING: Anyone who helps improve your property, but who is not paid, may record what is called a mechanics"lien on your property. A mechnics' lien is a claim, like a mortgage or home equity loan, made against your property and recorded with the county recorder. Even if you pay your contractor in full, unpaid subcontractors, suppliers, and laborers who helped to improve your property may record mechanics' liens and sue you in court to foreclose the lien. If a court finds the lien,is valid, you could be forced to pay twice or have a court officer sell your home to pay the lien. Liens can also..affect your credit. To preserve the right to record a lien, each subcontractor and material supplier must provide you with a document called a'20 -day Preliminary Notice.' This notice is not a lien. The purpose of this notice is to let you know that the person who sends you the notice has the right to record a lien on your property if he or she is not paid. BE CAREFUL. The Preliminary Notice can be sent up to 20 days after the subcontractor starts work or the supplier provides material. This can be a big problem if you pay your contractor before you have received the Preliminary Notices. You will not get Preliminary Notices from your prime contractor or from laborers who work on your project. The law assumes that you already know they are improving your property. PROTECT YOURSELF FROM LIENS. You can protect yourself from liens by.getting a list from your contractor of all the subcontractors and material suppliers that work on your project. - Find out from your contractor when these subcontractors started work and when these suppliers delivered goods or materials. Then wait 20 days, paying attention to the Preliminary Notices you receive. PAY WITH JOINT CHECKS. One way to protect yourself is to pay with a joint check. When your contractor tells you it is time to pay for the work of a subcontractor or supplier who has provided you with a Preliminary Notice, write a joint check payable to both the contractor and the subcontractor or the material supplier. For other ways to prevent liens, visit CSLB's Web site at www.cslb.ca.gov or call CSLB at 800-321-CSLB(2752). REMEMBER, IF YOU DO NOTHING, YOU RISK HAVING A LIEN PLACED ON YOUR HOME. This can mean that you may have to pay twice, or face the forced sale of your home to pay what you owe. TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY, YOU MAY WISH TO TAKE ONE OR MORE. OF THE FOLLOWING STEPS. ,; (1) Require that your contractor supply you with a payment and performance bond (not a license bond), which provides that ` the bonding company will either complete the project or pay damages up to the amount of the bond. 'This payment and performance bond as well as a copy of the construction contract should be filed with the County Recorder for your further protection. -The payment and performance bond will usually cost from 1 to 5 percent of the contract amount depending on the contractor's bonding indicate his or her financial incapacity. (2) Require that payments be made directly to sub -contractors and material suppliers through a joint control. Funding services may be available,. for a fee, in your area which will establish voucher or other means of payment to your contractor. These services may also provide you with lien waivers and other forms of protection. Any joint control agreement should include the addendum approved by the registrar. (3) Issue joint checks for payment, made out to both 'your contractor and subcontractors or material suppliers involved in the project. The joint checks should be made payable to the persons or entities which send preliminary notices to have lien rights on your property, and therefore you need to protect yourself. This will help to insure that all persons due payment are actually paid. (4) Upon making payment on any completed phase of the project, and before making any further payments, require your contractor to provide you with unconditional "Waiver and Release" forms signed by each material supplier, sub -contractor, and laborer involved in that portion of the work for which payment was made. The statutory lien releases are set forth in exact language in Section 3262 of the California Civil Code. Most stationery stores will sell the "Waiver and Release" forms if your contractor does not have them. The material suppliers, subcontractors, and laborers from whom you obtain releases are those persons or entities who have filed preliminary notices with you. If you are not certain of the material suppliers, subcontractors, and laborers working on your project, you may obtain a list from your contractor. On projects involving improvements to a single family residence or a duplex owned by the individuals, the persons signing these releases lose the right to file a mechanics' lien claim against your property. In other types of construction, this protection may still be important, but may not be as complete. To protect yourself under this option, you must be certain that all material suppliers, subcontractors, and laborers have signed the "Waiver and Release" form. If a mechanics' lien has been filed against your property, it can only be voluntarily released by a recorded' "Release of Mechanics' Lien" signed ' by the person or entity that filed the mechanics' lien against your property unless the lawsuit to enforce the lien was not and all such liens are removed. You should consult an attorney if a lien is filed against your property. Page 5 of 8 77 7-7 r;KK r�..;,LICENSED�CONTRA'CTOR < < a�:. p;,,� . "Statelaw requires anyone who contracts to do construction work to be licensed by the Contractors State License Board (CSLB) in the license category in which the contractor is going to be working if the total price of the job is $500 or more (including labor.and. materials). CSLB is the state consumer protection agency that licenses and regulates construction contractors. Contact CSLB for information about the licensed contractor you are considering, including information about disclosable complaints, disciplinary actions and civil judgments that are reported to CSLB. Use only licensed contractors. If you file a complaint against a licensed contractor within the legal deadline (usually four years), CSLB has authority to investigate the complaint. If you use an unlicensed contractor, CSLB may not be able to help you resolve your complaint. Your only remedy may be in civil court, and you may be liable for damages arising out of any injuries to the unlicensed contractor or the unlicensed contractor's employees. For more information; Visit CSLB's website at www.csib.ca.gov. Call CSLB at 800-321-CSLB (2752). Write CSLB at P.O. Box 260000, Sacramento, CA 95826. THIS AGREEMENT WILL NOT BECOME BINDING ON THE PARTIES UNTIL ACCEPTED BY AN AUTHORIZED REPRESENTATIVE OF ALLIANCE, AT ALLIANCE'S OFFICES. YOU, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE TH TT CHED THREE-DAY RIGHT TO CANCEL FORM FOR AN EXPLANATION OF THIS RIGHT. INITIAL o THAT YOU RECEIVED THREE-DAY RIGHT TO CANCEL FORM. �CUSTOMER: (Signature) C.Zag Cr - (Name Typed or Printed) Date: Corporate Office: Los Angeles/Orange County Office: San Diego: Ventura/Santa Barbara: Bay Area: Monterey/Santa Cruz: Riverside/San Bernardino: ALLIANCE ENVIRONMENTAL GROUP, IN BY: iggaj.ure (NameTyped orPrinted) Date: 990 W. Tenth Street "Azusa CA 91702 "' Ph. 626.633.3500 Fax:' 626.633.3599 978 W. Tenth Street "Azusa, CA 91702 "' Ph. 626.633.3500 Fait: 626.969.2793 8390 Juniper Creek Lane" San Diego, CA 92126 "' Ph. 619.229.6135 Fax: 619.229.6143 680 Flinn Avenue; Unit 32" Moorpark, CA 93021 "' Ph. 805.378.6590 Fax: 805.378.6594 3545 Victor Street" Santa Clara CA 95054 "' Ph. 408.830.9700 Fax: 408.980.9746 161 St. Andrews Drive" Aptos, CA 95003"' Ph. 831.661.0329 Fax: 267.613.0329 75715 Heritage West Palm Desert, CA 92211 "' Ph. 760.772.3841 Fax: 801.340.2943 . Page 6 of 8 i "THREE DAY RIGHT TO CANCEL" ii Project: i Enter. Date of Transaction You, the Buyer, have the right to cancel this contract within three (3) business days. You may cancel by e -mailing, mailing, faxing, or delivering a written notice to the contractor at the contractor's place of business by midnight of the third business day I' after you received a signed and dated copy of the contract that includes this notice. Include your name, your address, and the date you received the signed copy of the contract and this notice. If you cancel, the contractor must return to you anything paid within 10 days of receiving the notice of cancellation. For your part, you must make available to the contractor at your residence, in substantially as good condition as you received it, any goods delivered to you under the contract or sale. Or, you may, if you wish, comply with the contractor's instructions on how to return the goods at the contractor's expense and risk. If you do make the goods available to the contractor and the contractor does not pick them up within 20 days of the date of your notice and cancellation, you, may keep them without any further obligation. If you fail to make the goods available to the contractor, or if you agree to return the goods to the contractor and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice,'or send a fax, to Alliance, 990 W. Tenth Street, Azusa, California 91702, fax 626-633-3599 or e-mail to info@alliance-enviro.com, not later than midnight of (Date), it herby cancel this transaction. (Date). Job Name: Lambert, George Job Address: 53530 Avenida Villejo , La Quinta, CA 92248 Project Disclosure www.alliance-enviro.com Date:(� I l l Signature: �� e ,. Alliance Environmental Group specializes in reducing hazardous air pollutants and such work requires containment systems and attachments to control air movement and to complete the remediation of specified hazards. Alliance Environmental Group does NOT rebuild after remediation. Please note and be prepared to deal with the following checked items: All Remediation Jobs Paint, wallpaper, drywall, floor sealer, molding and trim damage will occur and is excluded. Such repair must be part of your finish work. Trim removed will not be re -installed by Alliance Environmental. Furniture / contents moving 3v packing is excluded unless specified. IT IS YOUR RESPONSIBILITY TO NOTIFY YOUR ESTIMATOR ABOUT SPECIAL CONDITIONS AT YOUR "SITE Acoustic Ceiling Removal Paint, wallpaper, molding and trim damage will occur and is excluded. Such repair must be part of your finish work. Trim removed will not be re -installed by Alliance Environmental. Ceiling surface will NOT be ready for paint. Plan and budget for floating and texturing. Some substrates may need to be demolished to remove the acoustic due to the installation and deffered maintenance. Fixtures, attachments, fans, vents and others will need to be removed with NO re -installation. Heater closets, above doors, under trim or inaccessible areas are excluded unless specifically noted. ® Flooring Removal Paint, wall paper, molding and trim damage will occur and is excluded. Such repair must be part of your finish work. Trim removed will not be re -installed by Alliance Environmental. Most base -boards will not be re -useable. When razor scraping concrete, a black mastic residue will be present. Most floors need to be floated for leveling. Chemical removal of mastic leaves an odor and some new floors will not adhere to the concrete due to the chemical makeup of the mastic remover. Substrate must be prepared by floor installer. Wood sub -floors may need to be cut by power saw. Be prepared for re -installation by floor contractor. Duct Removal Your attic or crawl space is considered pre -contaminated. ask and pay for the service. Alliance does not clean your space unless you specifically Over time ceiling joists loosen or sag. The added weight of a man may cause a crack in your ceiling. Alliance is not responsible for the integrity of your joist system. Page 8 of 8 71-780 San Jacinto Dr. Ste. E2, Rancho Mirage, Ca. 9270 ph. (760)-834-8860 fax (760) 834-8861 Letter of Transrntt To: City of La Quinta Today's Date: 78-495 Calle Tampico City Due Date La Quinta, CA 92253 Project Address: Attn: Philip Plan Check#: Submittal: ❑ 1St ® 2" d ❑ ❑ 3`d ❑ We are forwarding: ® By Messenger Includes: # Of Descriptions: Copies: 6-29-11 6-30-11 53-530 Ave Vallejo 11-540 4th e Other: ❑ By Mail (Fed Ex or UPS) Includes: ❑ Structural Plans ❑ Struct. Calcs I� ❑ Truss Calculations ❑ Soils Report ❑ ® 1 Structural Comment List ❑ ® 1 Redlined Structural Plans ❑ ® 1 Redlined Structural Calcs ❑ Redlined Truss Calcs ❑ ❑ Redlined Soils Reports ❑ Comments: Structural content is approvable. # Of Copies: 1 ❑ Your Pickup Descriptions: Revised Structural Plans Revised Struct. Calcs Revised Truss Calcs Revised Soils Report Approved Structural Plans Approved Structural Calcs Approved Truss Calcs Approved Soils Report Other: This Material Sent for: ❑ Your Files ® Per Your Request ❑ Your Review ❑ Approval ❑ Checking ❑ At the request of: Other: ❑ By: John W. Thompson Rancho Mirage Office: ® # (760) 834-8860 Other: ❑ AcoRv® CERTIFICATE OF LIABILITY INSURANCE DIDD/YVYY) L423/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s . PRODUCER CONT CT NA E: PHONE r FAX A� NO' 847-440-9126 Assurance Agency, Ltd. One Century Centre 1750 E. Golf Road E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Schaumburg IL 60173— INSURER A INSURED INSURER B INSURERC: Burnett Group, LLC INSURERD: dba Labor Finders 11426 N. Jog Road - Palm Beach Gardens FL 33418- INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 71 r,61S1;R4 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE A POLICY NUMBER PMOLICY EFF MM/DO1 EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx ] OCCUR PHPK591557 /30/2010 /30/2011 EACH OCCURRENCE $1,000,000 PREMDAMAGE R NTED I E aoccurrence) $100, 000 MED EXP (Any are person) $5, 000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC JECT PRODUCTS-COMP/OP AGG $2, 000, 000 $-- A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS PHPK591557 /30/2010 /30/2011 INED COMBSINGLEInMT— $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per ent $ _ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 1 1 PHUB313322 6/30/2010 /30/2011 EACH OCCURRENCE $5,000,000 AGGREGATE $5, 000, 000 DED I X RETENTION 10,000 $ S C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below N / A C4375315 C4375316 /30/2010 /30/2010 /30/2011 /30/2011 X I WC STATU- I I OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Workers Compensation: Excluded Officers/Partners/Members are: Jeffrey Burnett Proof of insurance CFRTIFICATF NAi nF:R CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN George Lambert ACCORDANCE WITH THE POLICY PROVISIONS. 53530 Avenida Vallejo La Quinta CA 92253 AUTHORIZED REPRESENTATIVE 9)1988-2010 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AcoRv® CERTIFICATE OF LIABILITY INSURANCE DATE`MM�°"Y"" 5 23.2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights fo the certificate holder In lieu of such endomemen s . PRODUCERNTACT NAME: PHONE FAx - A/c No : - - 9126 Assurance Agency, Ltd. One Century Centre 1750 E. Golf Road E-MAIL ADDRESS:_ INSURE S AFFORDING COVERAGE ---- NAIC# Schaumburg IL 60173- INSURER A INSURED INSURERB:Thp Insurance Company of the S INSURERC: Burnett Group, LLC INSURERD: _ dba Labor Finders 11426 N. Jog Road Palm Beach Gardens FL 33418- INSURERE: -- INSURER F : COVERAGES CERTIFICATE NUMBER: -iSRn49.RR REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUSR POLICYNUMBER POLICY EFF M POLICY EXP MM/DDlYYYY LIMITS A GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR PHPK591557 /30/2010 /30/2011 EACH OCCURRENCE $1,000,000 DAPRE MAGE TORENTEDorr urre 1 E aac noe $100, 000 MED EXP (Any one person) $5 , 000 PERSONAL BADVINJURY _ $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $2 , 000 , 000 $ — A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS PHPK591557 /30/2010 /30/2011 COMM7=NGLE LIMIT Ea accident $1,,.000, 000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE PHUB313322 /30/2010 /30/2011 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X I RETENTION $10, 000 $ B C WORKERS COMPENSATION AND EMPLOYERS'UABIUTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC4375315 WC4375316 /30/2010 /30/2010 /30/2011 /30/2011 X I WCSTATU- I OTH- ER E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE - EA EMPLOYE -- $1, 000, 000 E.L. DISEASE - POLICY LIMIT $1, 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Workers Compensation: Excluded Officers/Partners/Members are: Jeffrey Burnett Proof of Insurance Gabe Lambert 53530 Avenida Vallejo La Quinta CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C"gt�:e air n 19RR.2n10 ACORD CO PORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD T4hf 4 4 a," P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 7 77 -70 12 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits [MPM t NOTICE TO pROEEgTy OWNER 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 at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will Rot issue a building permit until you have read, initiaW your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OVA4ER'S AC K , WLE- Dt-_mwmT AND WERIEIiCA')rION O IN) t}I A'1 N DMECHONS: head and initial each statement below to signify you understand or verify this information- 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property - A 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. P 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit, i understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. !1� 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($504) including labor and materials, I may be considered an "employee' ,unde state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �� 7 .. I understand under California Contractors' State License Law; ,an Owner -Builder who builds single-family residential ctures cannot legally build them with the intent to offer them '.for sake,' unless all work is performed by licensed subcontractors and the number of structures does not exceed i four within any calendar year, or all -of the work is performed under contract with a licensed general building Contractor. 8 I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any nancia[ or personal iuiaries sustained by any subsequent owner(s) that result from any latent construction defects in the rfianship or materials. 9. I understand I may obtain more information regarding my obligations as an "employee' from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 80 21-CSLB (2752) or www_cslb.ca.gov for more information about licensed contractors. e 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: l 1. I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all appl' ble laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or fun is injured while worlQng on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are property licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing tgne permit. Note: A copy of the property owner's driver's license, f"m n6+4 or other verification acceptable to the agency is required to be presented when the permit is issued to verify the Pr*PaV owner's signature. l Signature of property owner Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the owner -Builder - AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S WHALE Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following persons) to act asmy agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. � � � � �� Scope of Construction Project (or Description of Work): C_-C) -t l [1 Project Location or Address: 5 3 — S 3 v tO-N e5-N t t) /A- AA&`rQ Name of Authorized Agent: C Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally felled out the abov information and certify its accuracy., Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required o bepresented when the rmit is issued to verify the property owner's signature. Property Owner's Signature: Dater ^4 5___11 — — i<s� State of eet� County of J li-- Kaz�'"'''t OFFICIAL SEAL YVON NE M LAGAN Subscribed and sworaldhmed to before me this__'5:_day of Aor L i' NOTARY PUBLIC-OREGON COMMISSION NO.445230 20_Jl—,byl-1 �� 1QoscM>rx MY COMMISSION EXPIRES JANUARY21, 2014 Notary Public /— t2 /� /�