9510-074 (RR)2 ' :-n, .---a LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
('o
License is in full force and effect.
r- W - License # U )Class C"Ezp. Date 3131195
r_ Z r4.
Date /Y3� a Signature of Contractor
CD 0 c) OWNER -BUILDER DECLARATION
J W 1 hereby affirm that I am exempt from the Contractor's License Law for the
1L following reason:
(A ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
N
rn WORKER'S COMPENSATION DECLARATION
CL Q I hereby affirm under penalty of perjury one of the following declarations:
o 2 Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO H O Cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
b J -D ( ) I have and will maintain workers' compensation insurance, as required by
M Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
W ul Carrier_ Policy No. _
? Z (This secti'0N °'d no't"$e completed if the permit Val uatioil` $^ 00.00 or less).
00 Cy() I certify that in the performance of the work for which this permit is issued,
C7 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 those provisions.
Date: 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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
riY*inspection purposes.
/Signature (Owner - ; /Agent) _ _ --- Dade
ALC i
BUILDING PERMIT
PERMITi
95 Tft.4o74
DATE Cif��
VALUATION g00LOT
TRACT
JOB SITE ADDRESS
APN
��5911 E4irT:. [1d.�1t
OWNER
CONTRACTOR
KO TECH ROOFMCI
r.*0E,I34 T1.I. BANKERS
8V,) AVE 45 V
54-590AVE. VE. D=
LND10 .r1 -91,11201
(.NDTA.N WELLS CA 923.10
t'8114 1925
DESIGNER/ENGINEER
USE OFPERMITvt�!+wt TUgiiNG
t�ea`OOt' .
FEE DESCRIPTION
FEES
CONY fft.c1CT AMOUNT 5,300.00 t,S
P041611T T+`.KE SUMMARY
l': ONS'f11UCT'I:ON,Fr2.F 10.71-000-118-000 33v.it#J`• .
' D q
0cr2.3
�
1
5
113
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3o.00
LESS PRE -PAID FEES
$U.(10
TOTAL :E'fit l4[M r FEE DIT NOW
$30.00
TOTAL
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 Zp ° o
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
Utility Notice (Perm)
COMMENTS:
0(:T -2? -1'=155 14:27 P.02
jotow"*am=loM ft*At^W*W WMAM#*>N wesKaa,,a..M 1ao,FM mars at***** �
f
0 -TECH -ROOFING COAVAkY
-670 HWY 131 SYR miss
OUINT� , CA 92:zt35
19) 7V* -64.77
19 ) !el%x
INN AaTHOMPS Ntad Tea
.,DWELL, BANKER
T. ANDREA GARLANO
5-7K27
NUMBER . T
SmItKy NO a O l
DATf[al0-•1� y�,
R"f�aalo*��wsi, .
a*s#�rrrwe*� LICENSE w►•1J.eS2S35
wash. To dr Parfav-favAt.a
5d -S90 AVENIDA DIA?
LAQUINTA (^.A
haraby propos+ to and oerferlal the labor niwwooarY for
a completion o-rof fiE �OF W/ NEW PLYWOOD RESET TILES
PULL UP TILE, INSTALL NEW.1/2 INCH PLYWOOD NAILED AS PER CODE,
INSTALL NEW TILE LINERik40 LBS'FELT NAILED AS PER CODE.
INSTALL ALL NEEDED ROOF METALS, TO COMPLETE 308.
RESET TILE ON ROOF INSTALL AS PER CITY CODE AND I.C.B.O.'REPORT.'
CLEAN UP JOB AFTER EACH DAY.
5 YEAR WARRANTY
Mater=al Los guaran%eed to be ao .spectfied, and the above work t.o be
foreadd in aeoordance with the drawings anal apeeifxeaaasonee efaA"jttecl for the
I've ilea -r ibed work and a l0te in a eoubet4kntial workmanlike manner for Lha
nto
55,500.00 -UPON �OMFLETION
lteretioe or deviation from the tbovs epecifloations. involvins extra
rill be oxocot.d only on mitten ordsTs, lad rill became to eytra,
e over ,nd above the estimate. All aore"Ilts ire eontiaotot upon etrikee
1nty or other dllere blrond our Captrol. 014nrr to CUTY fire, kOrntdo
li other eeceaeerr insurance upon the above nark, worntnIs compensation
ubllc Liability Insuranoe on abovf 1101 is to be provided by:
—TECH ROOFING COMPANY
�iGCf:PTANCE QF PROPOS-'
Re—m— p tfA11L pd .
David Krastel. OPerator
ABOVE: DAYC98, *PCCIPICATIONO AND GONVXYXOtvS ARE SATISFACTORY. ANA ARR.
any ACCi'PTem . YOU ARE. AU"THORZZCD TO 00 THC WORK AS SPKe%FIEC . opov 1ENT uIV-U
MACE AS OUTLXNED AAOVS .
signa�ura
aiipnatUr•
von%re.+wrwx or claLfn arlainaa, vut of ar relaainaa to thus oontrect ■ or the
%an CherapCf, ah*12 ba wattled by mfbirtration in aoapaard*n0e with the Uniform
sW for nettf►r INA :ora Burrau Arbiardtion, and the Judw4wMo"V, upon aha wwmwcf
yA.ator(
:rOd by thw rbitr
0) may be e�ntrarod in any Court h*vino JvrLSdi,pf:ian
-004.
W 7C VrNak* * * au V4 W %k 1M * * * M tal>tf M ak # * ak �/ a1�,la7R aRa11,M 111 Nt 7M�MOk a)r wcs
TOTAL P.02
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