0206-172 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ar,. liceps6l under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and.
N W Professionals Code, and my License is in full force and effect.
C =) ch License # Lic. Class Exp. Date
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Cy 61175038 C:39 N6112(
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/ bate `°' Signature of Contractor
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f` U a OWNER -BUILDER DECLARAT� N
ul rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
tD 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)..
�
() I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
IL
p � I hereby affirm under penalty of perjury one of the following declarations:
Lo Fa- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL 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 L) I have and will maintain workers' compensation insurance, as required by
O L Q Section 3700 of the Labor Code, for the performance of the work for which this
a m I— permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier S'j!AU? FUND Policy No. =0_442097
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(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
3 subject. to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall fortDwith comply with those provisions.
Date: rra. //� ? Applicaat-_ =:=z;— .
J� /• 1r � '
Warning: Failure to secure Workers' CO�mpensation coverage is unlawful, and
shall subject an employer to criminal penalties and civil fines up to $100,00, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code; interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth. on his
application. _
1. Each person upon whose behalf this application is made & each person at.
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above Information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. f�
Signature (Owner/AgenH-------`'--- ;- w -17 �- Date
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BUILDING PERMIT PERMIT# '` ---- •°
DATE VALUATION LOT TRACT
JOB SITE,
ADDRESS 77,460�CAILF D11R:kKG0
APN Try t-4Ai_fl12
OWNER
CONTRACTOR / DESIGNER / EN (NEER
V'ICKY JIrJBM-
7th-440k-'MMs'a70
.W. EZ
IA Q111►NTI-A C_'A 92253
922113
USE OF PERMIT
c3EI&1tr' L V f I. WIL1143
f,&R.00I?VYJT1•I SHIN ULR:3.t:LAiSSA, MATERIALS UNIX.
M"�.7. COST OF (;0f!IFF.��i"Ti CICION
PER .NMI FEW KOMM +rR111
P -Le .00FMIKE 101-000.418-000
1
)D(11'10N AND PI.,.10 CTI des"
IcE,00 PRK-l"AID M01.$
$0100
quid � :1 11J1lL -
iQ3 JPOW11`:I:1TY,F rOTIE NOW
cRy OF LAQUINTA
HMANCEDEK
RECEIPT
DATE, DATE.
�f.,/-
BY,
DTE PIN LED
INSP
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 < <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 Wail 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:
CUSTOM ROOFING COMPANY
38-980 RANCHO IAS COYOTES
INDIO CA 92203
PHONE: (760) 345-3751
DATE: June 7, 2002
TO: GO Vicky Johns
78440 Calle Felipe
La Quinta CA
JOB ADDRESS: 77460 Calle Durango
La Quinta CA
LIC. Na 655038 PROPOSAL NO. 4* 47-JOR-460-02
SHEET NO. 1
PROPOSAL ANDCONTRACT
SPECIFICATION AND UNDERSTANDING: Tear off existing roof and re -roof as follows: Nail down 1 layer base sheet
to roof deck_ Install new metal on edges, install valley metal where needed. Install 30 year, limited warranty, architectural, fiberglass,
dimensional shingles. Custom Roofing Company responsible for clean up and removal of roofing debris from property.
Note: Equipment may have to be driven.outo grass and/or yard. Custom Roofing not responsible for any damage.
SPECIAL INSTRUCTIONS AND NOTES: (1). A deposit may be required to cover the cost of material. Draws on
balance due may be:required. (2). Any sheeting needed will be an extra charge of $30.00 per sheet above contract price. (3). Any air
conditioners, water coolers, duct work, electrical, etc., that needs unhooked, moved, or removed from the roof will be the owner's
responsibility above contract price. (4). All home owner's or association fees to be paid by owner above contract price. (5.)
Equipment and Vehicles may have to be driven onto and left on yard, including grass areas. Custom Roofing not responsible for any
damage to such areas.
TOTAL COST: $3,400.00 (THREE THOUSAND FOUR HUNDRED DOLLARS AND NO CENTS)
TERMS: TO BE PAID IN FULL ON COMPLETION UNLESS OTHERWISE SPECIFIED IN THE CONTRACT.
FIVE (5) YEAR guarantee against leaks an Custom Roofing Company's work only.
NOTE. BECAUSE OF THE RAPID RISE IN THE COST OFMATERML THIS PROPOSAL WILL BE NULL AND VOID
AFFER I S DAYS JOB TO BESTARTED INA T7MELYMANNER ACCORDING TSD SCHEDULEAND WEATHER CONDITIONS.
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 any damage to roof due to any
cause beyond our control including, but not limited to, fire, lightning, windstorm, hailstorm, rainstorm, installation of antennas, or
other equipment, foot traffic on roof, structural fault or settlement, cracking or other failure of roof deck, walls or foundations of the
building•on which the roof is applied. (2} Should it become necessary for the roofing contractor to remove and/or reinstall any
antennas, cooling or heating appliances, or other equipment, whether or not any additional charge is made for such work, customer
understands that neither Custom Roofing Company, nor installer assumes any responsibility for the performance of said equipment.
(3). Custom Roofing Company does not assume any responsibility for existing code violations or for the installation of any existing
defects unless specified in the estimate and proposal.
ACCEPTANCE: You are hereby authorized to furnish all contents written in this contract to complete the work mentioned
in the proposal and contract for which I/we agree to pay the amount mentioned. in said proposal and according to the terms thereof.
IN KEEPING WITH INDUSTRY STANDARDS: It is understood that by the acceptance of this proposal you authorize
Custom Roofing Company to make the installation, to issue work order with specifications shown herein and to pay our charge for
such lirtstallation. You agree to pay Custom Rooting Company the amount specified herein, which will cover the price of said
materials and labor charges. Ibis estimate is based on complete job and any surplus material remains the property of Custom Roofing
Company. 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, governmental regulations, or any cause beyond our control. Any changes made by you in specifications herein,
necessitating additional materials or labor shall not be included or covered for by this proposal, but shall be provided for under a
separate and additional order from you.
OWNER'S SIGNATURE: DATE:
CONTRACTORS SIGNATURE: DATE:
(PLEASE SEEOTHER SIDE)