0109-165 (RR)LICENSED CONTRACTOR DECLARATION
I herebyaffirm'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
7111U C39 14 R9/30o2(
Date �/. _ ! Signature of Contractor ti
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, B6s;ness & 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
S
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.
F6X,'&;'lo FIT
(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 Carlifo ni , apd, agree that if I should become
subject to the workers' compensation pr visions of fiction 3700 of the Labor
Code,,Adll forthwith comply with tho'e (avis
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to -criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
,any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby aythQrizp representatives of this City to enter upon
the above-mentioned propertVf$r ns ection puR oses.
Signature (Owner/Agent) �� + Date
PERMIT# �.
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE a+ + e. ..
ADDRESS
APN
,.
qr/15 AYENU}A =47.
52-615
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KA LEL C3UR W
kOME 3iE3t MNG'' CO.
fi "�iaS.dt ]I3A1t�.t
65-947 CrAIRU'iI h
!AqUINTA CK 92253+ERT
HOT Sr)R. G, CA
X92240
(760)28f3-'32097 CS11411
'
USE OF PERMIT r , _4
11"; 2Ot5.ff' Y ,PsvF'iiALT Sii.tNC LFL (Cf -ASS °. ''MRP; RATING REQ111r ,111).
1f .t�AbrAl,SU, dV J:' ,%00.00 LS
A B%XMA a 7A].iV'J.L;Ni19.C�
x
I
SEP 18 2001 t
CITY OF LA QUINTA
FINANCE DEPT....._ _... E
f` 1.17 -11*0 [°PJa f_ CriWTTROITUIX .t►,?,�i'.f'3. P'i./+.W CF�i^a .�:
$fit). Qa
14OW
MOD
RECEIPT
DATE�Z
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 y
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
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
Iz:Jnderground Conduit
Rough Wiring -
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.FJ.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
LIC. NO. 785158
d
;►
I�
' FOOTE
ROOFING
SEPT 9) 2001
KAREN DURAN
52-615 AVENIDA DIAZ
LA QUINTA) CA 92253
RE: REROOF
PROPOSAL
Residential • Commercial • Re -Roofing
Co . 65-947 Cahuila Ave. • Desert Hot Springs, CA 92240 • 760-288-3207
JCB ADDRESS:
1. TEAR OFF EXISTING ROOF SURFACE DOWN TO BARE WOOD SHEATHING.
2. REPLACE WOOD SHEATHING AS NECESSARY (I.E. DRYROT) TERMITES) AT
AN ADDITIONAL CHARGE OF $2.00 PER SQUARE FOOT.
3. REPLACE OTHER WOOD (I.E. FASCIA) STARTER BOARDS) AS NECESSARY AT
AN ADDITIONAL CHARGE OF $4.00 PER LINEAR FOOT.
4. INSTALL ONE (?.) LAYER OF 15# ORGANIC FELT UNDERLAYMENT TO ROOF
SURFACE.
5. INSTALL METAL DRIP EDGE TO PERIMETER„ (GALVANIZED).
6. INSTALL ELK OR EQUAL FIBERGLASS DIMENSIONAL SHINGLE 30 YEAR
MANUFACTURERS WARRANTY, OVER UNDERLAYMENT.
7. INSTALL PREMIUM RAKE AND RIDGE SHINGLES TO ALL RIDGES AND
GABLE ENDS.
8. SEAL AND PAINT ALL PIPES AND VENTS
9. REMOVE ALL ROOFING DEBRIS FROM THE PREMISES.
FLAT ROOF,
�O. INSTALL ONE(1) LAYER OF GAF OR EQUAL OF 289 FIBER6LA.S3'=
SHEET NAILED,_ IN PLACE AfC.O, 1 T
N
I••......$3740.00 `
w, urrucred larger than the pions show, this contractor will be paid for the extraceptance by both pores
hereto except as contained herein or endorsed hereon.
es a contract when and only when• signed by both Parties hereto,
—gement awarded shall include court costs and reasonable attorneys fees
_ DAY OFi r