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0311-005 (RR)LICENSED CONTRACTOR DECLARATION , I hereby affirm under penalty of perjury that I am licensed under provisiois of Chapter 9 (commencing with Section 7000)_9f Division 3 of the Business and Professionals Code, and my License:is in full force anffect. License # �' �ami"effect. �Liiic,. Class Exp. Date D�e�k 1-2,"11 f % Signature of Contractor i/ ` t —k— 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 71fj.u9' .A.MA�3s�'".:A.N' .OT Policy No. n1l a2"A2,291 (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 Calif6mia, a ill- subd agree that if I should become ject to the workers' compensation provisions -of Section 3700 of the Labor ,Code, I Sall,forthwith comply with those provisions'` Date: t�— 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 prop, jy for inspection purposes. ” ateyy �. Signature (OwD ner/Agent) `• aA l PERMIT t/ BUILDING -PERMIT DATE VALUATION LOT _ TRACT " i,Efl?�P2?43C $OW6.00JOB SITE APN ADDRESS 'jam:.�Qg� ea� OWNER— CONTRACTOR/DESIGNER/EN INEER JAI 'WE L ER ROOF TME SPECli?,YITY, "TC:. 79-€369 I•IC7N04NIUBTRD LANE 74.9$0 RT:I ,AWAY BAY M LAQlJ-ZT3:A C:A, 92253 Wx;llMUDADtMTFS CA 92211 (760)200.0811 MDO 1420 USE OF PERMIT ea..'F�"1..Mx!'.DDR3. INAZOO? LIOf3`f`-%`EIEC HT T'1LiY 2001 C8C. I VALVJ%T10).4' L3 ' Ii+3 CiVf 1711: COST' OF t',ONYMVITLON PEWINT T Fb' E 9UMMARY 'GOOF FEL l iia X000 -t1 l f���JOC $(1.pf1 MUMONAAN PLAX CWECK $30,00 D 1ASS .PR .-PAl7)1e`, MB $0.00 PORMT . 97016 yu-c NOW QVlNTA OEPT' �' C1TM��gyCE RECEIPT' DATE �) BY rG/ DATEFINALED 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 8 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 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) RTS Roof Tile Specialty, Inc. Contractors State License # 810537 P.O. Box 11257,Palm Desert, CA 92255 PHONE 760-200-0811 FAX 760-200-0801 A proposal submitted to: JAMIE MILLER Mailing Address: 79869 HUMMINGBIRD LA QUINTA, CA 92253 Job Address: SAME AS ABOVE Phone: Description of work to be performed: OBTAIN ALL REQUIRED CITY PERMITS. REMOVE EXISTING ROOF AND DISPOSE, CLEANING ALL GROUND AREAS. INSTALL %, PLYWOOD OVER SPACED SHEETING PER CODE, RIDGE BOARD AND NEW NAILERS PER SPEC. INSTALL CANT STRIP AND TAPERED CANT AT ALL ROOF TO WALL TRANSITIONS ON FIAT ROOF AREAS. NAIL ONE LAYER 40# TILE LINER TO ALL PITCHED AREAS OF THE ROOF. NAIL ONE LAYER GLASS BASE TO ALL FLAT AREAS OF ROOF. HOT MOP THREE LAYERS GLASS PLY 6 OVER PREPARED FLAT ROOF. MASTIC AND WEB ALL TERMINATIONS AND COVER WITH GRANULES. FLOOD COAT ROOF WITH HOT ASPHALT AND COVER WITH ROCK. INSTALL NEW SHEET METAL AT ALL ROOF TO WALL SHEET METAL. INSTALL LIGHT WEIGHT ROOF TILE TO MANUFACTURES SPECIFICATIONS. BID INCLUDES ALL NEW SOFT JACKS PAINTED TO MATCH ROOF. CLEAN JOB SITE TO OWNERS STANDARDS. Note: In keeping with.industry standards: 1. This guarantee does not cover any damage to the interior or exterior on which the roof is applied or damage to any contents therein. This guarantee does not cover damage to roof due to any cause beyond our control, including, but not limited to: fire, lightning, windstorm, hailstorm, antennas or other equipment, foot traffic on roof, structural fault or settlement, cracking or other failure of the roof deck, walls or foundation of the building on which the roof is applied. 2. Should it become necessary for the roofingcontractor'to remove and/or reinstall any antennas, cooling or heating appliances or other equipment, whether or not an additional charge is made for such work, the customer understands that neither RTS (Roof Tile specialty, Inc.) nor the installer assumes any responsibility for the performance of said equipment. 3. RTS (Roof Tile specialty, Inc.) does not assume any responsibility for corrections of existing code violations or for the repair of any existing defects unless specified -in estimate and proposal. Total Cost: $15.366.00 Terms paid on completion unless otherwise specified in the contract. If not accepted in thirty days this proposal is invalid. An additional cost of $35.00 per sheet of plywood will be charged if plywood needs to be replaced. 'Acceptance: You are hereby authorized to furnish all contents written in the contract to complete work mentiSefects proposal contract for which Uwe agree to pay the amount mentioned, in said proposal, and according to terms thereof,tial). If a leakage, caused by defects in workmanship, occurs within TEN years from date of application, we will repae of charge. Installation: It is understood that by the acceptance of this proposal you authorize RTS (Roof Tile specialty, Inc.) to make the installation; to issue work orders with specifications shown herein and to pay our charge for such installation. You agree to pay the amount specified herein, which will cover the price of said materials and labor charge. This estimate is based on a complete job and any surplus material remains property of RTS (Roof Tile specialty, Inc.).. Verbal understanding and agreements with representatives shall not be binding unless set forth herein. There shall be no liabilities for delays in, or failure to complete, deliver or installation of all or any of the herein mentioned merchandise, if due to fire, strikes, war, government re ations or any cause beyond our contract, Any changes made by you in specifications herein, necessitating additional materials oTlanot be included or.covered by this proposal, but shall be provided for under separate and additional order from you.Arbitration of Disputes: Any controversy or claim arising out of or relating to thct, or the breach thereof, shall settled by arbitrator in accordance with the applicable Construction Industry Arbitrator Rules of the American Arbitration Association which are in effect at the time the demand for arbitration is filed. A judgment award based upon the evidence presented by the party(ies) who do (does) appear and participate. Notwithstanding Contractor's right to arbitrate, contractor does not waive any of its lien rights. In the event of default by client in payment of the amount due hereunder, client agrees to pay reasonable attorneys' fee's and cost incurred in connection with collection of said amounts whether or not suit is filed. 1.5% per month and/or an annual percentage of 18.0% will be charged on all past due accounts. Contractor's are required by law to be licensed and regulated by the Contractor's State Board. Any questions concerning a contractor may be referred to the register of the board whose address is: Contractors State Licenses Board, 9835 Goathe Road, Sacramento, CA 95827. Mailing address: P.O. Box 26000, Sacramento, CA, 95826. The above prices, specificati s and conditions are satisfactory and are hereby accepted. Owner's -Signature Date: (or authorized representative Contractor's Signature Date: