0401-035 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Qusiness and
til W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class /"` Exp. Date
787079 C3
r Cy Lin
C:) Z r --/Date-!` �' Signature of Contractor
Y
rU p OWNER -BUILDER DECLARATION
HLLJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
ce) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
CL
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
D � Q Section 3700 of the Labor Code, for the performance of the work for which this
11 rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier 1-14T, CAFTNE.COMM. Policy No. ^jNJ-0 JA 91
aD �
r` a
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,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree th�tsifal shouldA become
subject to the workers' compensation provisions of Section 3700 of the Labor
3 Code, I shall forthwith comply witKillose provisions.
Date: / %`7�Ca Applicant--�..rf z n
r o - ..
• Warning: Failure to secure W kers' 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)`-` "=-,f Date
BUILDING PERMIT PERMIT.ryry",.��l7EY
.'
DATE umn VALUATION ,�s,m LOTH `) TRACT
JOB SITE
ADDRESS :12.-4.0,AV�:N ADIAZ J%[ ,� APN -
OWNER tONTRACTOR / DESIGNER / EN (NEER
MAPJ0..BA3iRE1:U\ 9CT3Ti34V . 7°T#e" QE7�TC
52.430 AV.HNTIV A DIAZ 62.5q) MI1XS .AV.[- 4:102 DTID1C CA 92201
I.P.,QUON'1A CA 52253 13 D10 CA 92201
(760)578-3735 L13LP 0525
USE OF PERMIT
GTO 1KRAL BURZINO
CI.ASa A
V'AL UA.TI014
51000.00 I.9
ES11MATK.) COST OF CC' ffS T12UCn'0N'
1TIZATIT k ; SUMMARY
RX GOOF T+•E:[~< 101-000-418-000 $30.00
M
i X11 07 2004
ITl OF L-A " 6—
P
i
SAID-TO AT, COMT'MUL`i7ON .AND 1'L0.N C'13ECK
IMM 1?lTE•PA,7U:[TVFS
TC'TAb PE %2KrF k FAN 1) UF NOW
RECEIPT DATE_, r BY .:� w _ _ 17
F_ -CG / INSP OR
51M)100
$30.00
$0100
$X00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
. Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
`
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp`Qower Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
SOUTHWEST ROOFING
P.O. BOX 126
Indio, Co. 92202
(760)57&3735(760)775-9697
CONTRACT PROPOSAL
License no. 787029
Contractor: Address: 52-430 Avenida Diaz
Owner: Maria E: Barr -era.: Job Site: La Quinta,Ca. 92253
WE PROPOSE AND AGREE to furnish required labor material for Tear
off
o 1 d
roof and r e r o o f .
ANY BAD SHEETING DISCOVERED NOT INCLUDED
IN
THIS
BID.
for the above named building using 3Q year shingles. , 1 layer #15 base ,flashing s
.4 -rip "edge: .
in accordance with submitted plans and specifications, for the sum
Of.F.T.VE.:THQU$A.ND "DG.LfARS . ($ 5, 00Q_)(1ID11ars
'TtHRF.F .YFAR WARRANTY
Shingles Color
ALL PAYMENTS TO BE 100% ON COMPLETION UNLESS OTHER WISE SPECIFIED ABOVE.
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1101 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 Contracotr's written acceptance hereof or upon the Contractor's
commencing performance and upon such acceptance or commencements of performance this shad 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 is further understood that:
(A) The Contractor shall not be responsible for damage or delay due to strikes, fires, accidents or other cause 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 repesentative of any person, firm, or corporation.
PRICE SUBJECT TO CHANGE AT ANY TIME TO REFLECT INCREASED MA PRICE
Date 7_ 0 L/ A r ed b outh t
accept the above proposal.