0112-088 (BLDG)LICENSED CONTRACTOR DECLARATION
Uji' I hereby affirm under penalty of perjury that l,am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04w . Professionals Code, and my, License is in full force and effect.
O =11 License# Lic. Class Exp. -Date
r- Z r- Date Signature of Contractor t.L�
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` J U C> OWNER-BUILDER'DECLARATION -
W W I hereby affirm under penalty of perjury that I arri'exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 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). ,
M () I am exempt under Section B&P.C. for this reason
LID
N Date Signature .of. Owner 4
O � ;
Q WORKER'S COMPENSATION DECLARATION
IL
p 2 z 1 hereby affirm under penalty of perjury one of the. following declarations:
Lin HCc
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
m_ Q performance of the work for which this permit is issued.
Q U I have and will maintain workers' compensation insurance, as required by
id U Qectllon 3700 of the Labor Code, for the performance of the work for which this
it LOH permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier PC icy No.
co 5 RATE i�s?�' D 1��J�03.9•�i
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J (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,
T 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
i Code, I shall forthwith comply wit ``those provisions.
i 6 Date: 447-10 "X e Applicant
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Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
ti of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made, to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application..
I. -Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta,. its officers, agents and employees.
2. Any permit issued as a result of this: application becomes null• 'a nd void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for•:inspection urposes.
r
,f Signature (Owner/Agent) t :' `� . _�_ �4&44 Date
=13
riU-IrLDING PERMIT PERMIT#
DATE _ VALUATION LOTTRACT
JOB SITE APN
ADDRESS
1%1-f �j
A,AA:wi"-rZ03D�Mr «
OWNER CONTRACTOR / DESIGNER / ENGINEER «
R,Ci4 ALD,M C tZP,.''ALT ; H :fibEWRC3OMG WC
5.36165.1 VICNIDA,` ELASCO WWEVA ROAD
LA Q'C'6.N TA i CA 92253 rA1;,M 111PRINGS11 Oda 912.E
(760)527r.3393 CSU 326
USE OF PERMIT
MIM MITYIEWWO
VALUATION
�as.00
Cff YQFLkQUKTA
�oaeeeer ,�
EN'TDAAmArD Can or columurallaw, 3$ .5.01D
"•3�i Cb3� fl 101.000.4I8.000
RECEIPT DATE BY, ' DATE FINALED INSPECTOR
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 - . 1,
Utility Notice (Perm)
COMMENTS:
^_
License. 0. 409619 CONTRACT PROPOSAL
Contractors are required by law to be
licensed and regulated by the Contractors'
DEW ROOFING, late Licensecont Board. Any referred
con-
UvLoe �% � - INC.e eernlnp a contractor may be referred to the
I l reglelror of the board whose address le:
640 Williams Road - P. O. BOX 914 Contractors' state License Board
7PALM SPRINGS, CALIFORNIA 92263 lent "N" street
Sacrament"N"
California gbet+
Phone (760) 327-3393
Contractor: Address: 40-725 Meadow Lane, Palin Desert, CA. 92260
Owner: Ron Millspaugh (cellular: 333-2515) Job Site: 53-665 Avenida Velasco, La tint a, Ga
WE PROPOSE AND AGREE to furnish required labor and material for RerOof HOUSE & GARAGE ONLY
ANY BAD SHEETING DISCOVERED WILL BE REPLACED AT OWERS' EXPENSE, NOT INCLUDED IN THIS BID!
for the above named building using 1 layer 3011 Felt & 25 -Year Fiberglass Shingles
in accordance with submitted plans and specifications, for the Sum of
Three Tholtsand Four Hundred Seventy Five and no/cents
.(.$ 3,475.00 ) Dollars
PATIO: Reroof using 1' layer Glass Base, 2 layersGlass Ply hot -mopped & 7211 Glass Cap„ADD $ 350.00
3 Year Guarantee ON WHATEVER WE REROC)F. I S eA_t.
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IF YOU WISH THE WORK TO BE DONE, SIGN THE CONTRACT PROPOSAL BELOW THE DATE AND ALSO ON THE BACK OF THE
SECOND SHEET, WHICH IS THE "NOTICE TO OWNER.” WE ARE SENDING TWO (2) COPIES EACH OF THE CONTRACT PROPOSAL
AND NOTICE TO OWNER. PLEASE RETURN ONE (1), COMPLETE SET TO US.
Approximate starling date: Approximate Completion date:
ALL PAYMENTS TO BE 100% ON COMPLETION UNLESS OTHERWISE SPECIFIED ABOVE.
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1181 et seq.),
any contractor, subcontractor, laborer, supplier or other person who helps to Improve your
Property but is not paid for his 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
and 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 remains unpaid."
This agreement shall become binding only upon the Contractor's written acceptance hereof or upon the Contractor's commencing
Performance and upon such acceptance or commencement of performance this shall constitute the entire contract and be binding upon the
parties hereto, there being no covenants, promises or agreements, written or oral, except as herein set forth.
It If further understood that:
(A) The Contractor shall not be responsible for damage or delay due to strikes, fires, accidents or other causes beyond his reasonable control.
(B) The proposal is limited to days acceptance from date hereof.
C) The Purchaser Is dealing with the Contractor as principal and that the Contractor Is not acting hereunder as the agent or rep! e- )nlative
of any person, firm, or corporation.
PRICE SUBJECT TO CHANGE AT ANY TIME TO REFLECT INCREASED MATERIAL PRICES.
IJ/15/00
DEW ROOFING, INC.
_ accept the above proposal.
By: Salesman
Approved by:L1L"/wZ_V/
l- .