9711-020 (RR)LICENSED CONTRACTOR DECLARATION
-,*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
ate tl• ;'T' 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.
( ) 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 Policy No.
,'rAI'E FLIND 457624-97
(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 ihose,provisions.��`r
ltIate: s 'L' Applicant—
Warning:
pplicant 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 PERMITN CON6245
TR//O��L#
DATE VALUATION LOT 97i1�C1:1Q TRACT ? 4 5
11/ 7/" $10,658.00 V V
JOB SITE APN
ADDRESS
794180 HORSESHOELN
OWNER CONTRACTOR / DESIGNER / ENGINEER
RIC,H.A:RD W MILN'E WESTERN PACIFIC: ROOFING
79890 HOR.SFSHOE RD 3462 LA. CAMP.ANA NVA'Y
LA. QUW_A CA. 9225:3 PALM SPRINGS CA 92260
014)1320.6022 C BL# 4293
I USE OF PERMIT
ARE-ROOF,C>'� PAIISTING WOOD SHAKE, INSTALL PLYWOOD RE
SkENOLF, INSTALL P01,YERr.MNF FOAM GRADE FR4630
REIROOF
10,658.00 LS
ESTIMATED COST OF CONSTRUCTION
PERMIT FEE SUMMARY'
REROOF FIS 101-000-413--M $X).00
y�r,s�ar.ur�
N 5 -TOTAL CONSTRVal'IO.N AND PLAN CHECK $30.00
LESS PRE -PAW `GEES $0.00
NOV 10 1997
f
RECEIPT I DATE
TOTAL PERMIT FEES DUE NOW S30.00
' BYE DATE FINALED INSPECTOR
f
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 6 L i
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
Sewer Connection
Encapsulation
Gas Piping
Gas 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)
WFCTFRN PA CTFIC
October 15, 1997
Ms. Carol Milne Lrr
79-880 Horseshoe Ad.
Ta•l w4W,e44, CA. ' iL"
LA Q✓iN Cq
Koojing Lorporanon
RE: Re -roofing Project;
Application of a polyurethane foam and acrylic coating roofing system over garage.
Application of 25 year dimensional shingle roofing system.
Dear Ms. Milne,
Thank you for the opportunity to inspect the roofing system on the above referenced property. Having
done so we are pleased to submit our recommendations and proposal for the installation of a polyurethane
roof system and the installation of a 25 year dimensional shingle roofing system. The recommended scope
of work and associated costs are as follows:
GENERAL
Unless expressly stated to the contrary, the contractor shall be responsible for performing the following
acts.
DESCRIPTION
A. The general conditions of this standard construction contract shall form a part of these
specifications with the same force and effort as though repeated herein.
B. The contractor shall furnish all labor, materials, equipment, permits, contractor's licenses,
insurance certifications, etc., to perform all operations required and specified. The contractor
shall provide labor and material customarily included in work of the same nature to give a quality,
complete job.
C. If unexpected conditions are encountered during the work, and the conditions adversely affect the -
cost or progress of the work, the contractor will notify the owner immediately, and the owner will
negotiate a change -order to resolve the unexpected condition.
D. The Contractor shall occupy, use, and permit others to use the premises only for the purpose of
completing the work to be performed under this contract with the Owner. The Contractor shall
not authorize or permit any other person to use said premises for any purpose whatsoever.
Western Pacific is to be given all reasonable set-up and staging areas.
3462 La Campana Way • Palm Springs, CA 92262 • (619) 416-5877 • Fax (619) 320-8912 _
Ms. Milne
Page 2
E. Contractor's scope of work shall not include the identification, detection, abatement,
encapsulation or removal of asbestos or similar hazardous substances. If Contractor encounters
any such products or materials in the course of performing its work, or if such hazardous materials
are encountered by any other firm performing work at the jobsite and contractor determines that
such materials present a hazard to'its employees, contractor shall have the right to discontinue its
work and remove its employees from the jobsite until such products or materials, and any hazards
connected therewith, are located and abated, encapsulated or removed, or it is determined that no
hazard exists ( as the case may require), and contractor shall receive an extension of time to
complete its work hereunder and compensation for delays encountered as a result of such situation
and correction.
SURFACE PREPARATION (FOR BOTH ROOF SYSTEMS)
PREPARATION -TEAR OFF
A. Remove all existing wood shakes roofing, and composition base flashing.
B. Install 1/2" plywood sheathing over space board.
C. Install new 2X2 eve metal around perimeter.
D. Clean roof of all debris.
APPLICATION OF POLYURETHANE FOAM AND COATING (over garage only)
A. Remove, any contaminants that will interfere with the total adhesion of sprayed urethane foam to
the substrate. Surface shall be free of loose particles, rust, scale, grease, direct latent moisture, old
roof or other contaminants
B. Roof deck shall be primed with Neoprime primer at the rate of .33 to .50 gallons per 100 square
feet.
/.SA
C. Urethane foam insulation shall be sprayed -applied to a nominal thickness K (plus or minus 1/4
inch) over the entire roof surface. Only 3 lbs. density foam will be used in this application.
D. Coating shall be applied in a minimum of two (2) separate coats. Acrylic coating to be 60%
solids, ( plus or minus 2%):
a. The base coat shall be applied at a rate of 1.50 gallons per 100 square feet.
b. The top coat shall be applied at a rate of 1.50 gallons per 100 square feet, yielding a total
system thickness for both coats of 22-24 Total Dry Mils.
C. During the final top coat application, size #11 granules will be embedded into the wet top
coat material at a rate of 50 pounds per 100 square feet. The top coat color and granules
will be white.
d. All foam is to be coated. Coating shall extend up and over all foamed vent pipes and
terminated a minimum of 2 inches above the foam, creating a neat appearance, self -
terminating flashing.
WESTERN PACIFIC
Hoofing Co'pormion
Ms. Milne
Page 3
This specification meets manufacturer requirements, Underwriter Laboratory
specifications and ICBO compliance. This system, when applied over an existing fire -
.rated Class A or B built-up roof system has a UL 790, A classification. When applied
over an existing C rated roof system, the existing rating remains. RTC ICBO # ER 4630
POLYURETHANE FOAM COST: $988.00
WARRANTY
A Five (5) year labor and material warranty will be issued upon completion of the roof and final payment
is received.
INSTALLATION OF A 25 YEAR DIMENSIONAL ROOFING SYSTEM
APPLICATION OF DIMENSIONAL SHINGLES
A. Install one layer of 910 underlayment mechanically fastened.
B. Install new 2X2 eve metal around the perimeter of the building.
C. Install shingles to Manufactures' specification.
SHINGLES COST: $9.,670.00
CONTRACT AMOUNT
POLYURETHANE ROOF SYSTEM...............................................$988.00
25 YEAR DIMENSIONAL SHINGLE ROOF SYSTEM..............6$9 70.00
TOTAL CONTRACT AMOUNT: $10,658.00_g, �3. jrt Initial
WARRANTY
A five (5) year labor and materials warranty will be issued upon completion of the roof and final payment
is received.
PAYMENT TERMS
A 10% deposit upon approval of the contract: Balance due upon completion and paid within 10 days of
receipt of the invoice.
The price quoted has been structured to reflect standards we assume are mutually desired: quality
installation, service reliability and long term performance. The price may be subject to change 15 days
from the date of this proposal.
WESTERN PACIFIC
Roofing cow -lion
,4ew\t
Il
S
Ms. Milne
Page 4
if you are in accordance with the conditions herein and the General Conditions enclosed, ,:lease execute the
agreement below and return both copies to this office. We will, in turn, sign them and return one copy to
you. Thank you for your cooperation in expediting this contract for your roofing needs.
NOTICE TO OWNER
Contractors are required by law to be licensed and regulated by the Contractor's State License Board.
Any questions concerning a contract may be referred to the Registrar, Contractor's State License Board,
P.O. Box 26000, Sacramento, California 95826.
ACKNOWLEDGMENT: Owner acknowledges that he has read and received a legible copy of this.
agreement including all terms and standard provisions before any work is performed and that he has read
and received a legible copy of every other document that owner has signed during this negotiation. Uwe
hereby acknowledge under the penalty of perjury that Uwe am/are the legal owners and am/are authorized
to sign this contract as an agent of the legal owner.
ACCEPTANCE: The above prices, specifications and conditions are satisfactory and are hereby
If accepted. You are authorized to do the work as specified. Payment will be as outlined above. You,
the buyer may cancel this transaction at any time prior to midnight of the third business day after
the date of this transaction. See the attached Notice of Cancellation for an explanation of this right.
Owner has the right to require contractor to have a performance and payment bond.
HOMEOWNER
Authorized Agent
W7 PACIFIC ROOFING, CORP.
Authorized Agent
/ G /,;?- 1/ / 1 7 �A,,F CAw�OAGwA 110-11Jlq 7
Date Project Manager Date
WESTERN PACIFIC ROOFING HAS THE RIGHT TO RESCIND THIS CONTRACT WITHIN FIFTEEN DAYS OF
ACCEPTANCE. THIS AGREEMENT IS NOT BINDING UNTIL ACCEPTED BY THE OFFICE MANAGEMENT AT
3462 LA CAMPANA WAY, PALM SPRINGS, CA 92262. NO CHANGES OR ADDITIONS TO THIS AGREEMENT
SHALL BE EFFECTIVE UNTIL OPROVO BY WESTERN PACIFIC MANAGEMENT.
MANAGERS ACCEPTANC9�DATE
0too1 �'t o F - '�, obs g
WESTERN PACIFIC
Roofing Coryomrion