9806-001 (RR)LICENSED CONTRACTOR DECLARATION
hbreby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
lV W Professionals Code, and my License is in full force and effect.
an
� License # Lic. Class Exp. Date
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~ Z ti UDale x J Signature of Contractor-
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ontractor `" f ` ` %�' '� v •�'
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U OWNER -BUILDER DECLARATION
W Lu I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
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).
CO3 () I am exempt under Section , B&P.C: for this reason
L
N Date Signature of Owner
O Q,
a Q WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
H0 () 1 have and will maintain a certificate of consent to self -insure for workers'
>< UJ P compensation, as provided for by Section 3700 of the Labor Code, for the
J Qperformance of the.work for which this permit is issued.
n Q (� (�(j I have and will maintain workers' compensation insurance, as required by
:5 L) Q Section 3700 of'the Labor Code, for the performance of the work for which this
1 rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
IT Z CarrierPolicy No.
STATE
(• a
QJ (Th!s.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
C/de, Inc all f9rthwith comply with those provisions. `
Date: Ed'' `? Applicant .'i. J,a`«
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 R
application. .,,
et
1. Each person upon whose behalf this application is made each person a
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 fo (inspection purposes.
Date
vSignature (Owner/Agent)
BUILDINGPERMIT
PERMIT#
CONTROL?
DATE X 14)8 VALUATION Ss.00 t o LOT
TRACT 7 x 2 7
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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nECEIPT
DATE
By, ,
DATE FINALED
INSPECTOR
USPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
SMONG APPROVALS
MECHAMCAL 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
SLL,OCKWALL APPROVALS
POOLS a SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUfilfdMMG 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)
ELEC` RiCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Paneis
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Ubltty Notice (Perm)
RUBEN M. VASQUEZ ROOFING
45-020 ELM STREET (619) 347-5683
INDIO. CA 92201
UC. NO. 451111498
,19 9 8 . TO A,;fF7C ,A,
77-805 CALLE DURANGO LA QUI�NTA. CA. ,(here;nalter••owner").Telephone no.
( )
'VASQUEZ ROOFING
_ (hereinafter "Contractor")
proposals) to furnish all materials and perform all labor necessary to complete the following: IInsert a description of the work to be done and a description of the materials to
be used and the equipment to be used or installed, and state the address of the job site.]
1. PE,!{OVF OLD ROOF CO�WLETELV AND REROOF USIA+!G CONCRETE ROOF TILE rV EAGLE TILE.
TILE {TILL BE LIGHTWEIGHT UITH 041NERS CHOICE OF COLOR. ENGINEERS* :REPORT WILL
SE 2ESPONSIEILITV OF 000ER.
2. ,MAIL Oil ONE PLY OF 40# TILE LIBER AND INSTALL ALL :METAL PERTAINING TO ROOF.
3. CLEAN ALL ROOF DEURIS UPON COMPLETION
4. PAINT ALL ROOF JAC\'S TO MATCH ROOF TILE.
5. GUAIZANTEE ROOF LABOR FOR FIVE YEARS FROi,� DATE OF COi,!PLETION
All of the above work is to be completed in a substantial and workmanlike manner according to standard practices for the sumlof
FIVE T�,'OUSiJID THREE NUNDP.ED Dollars($ 5300.00 ),
Progress payments shall be made as follows: PAYiVENT OF M'ATERi LS NILL SE MADE UPON DELIVERY OF r'.f11 E RIAL TO
JO iS I TE.
to the value of XXXXXXXXAA' 'X' XXXXX ,) of all work completed.
The remaining balance of the contract is to be paidMani!
[jpn (rcompletion.
This proposal�is valid until ��XXXX;CX::XXX if accepted on or before that date, work will commence approximately onXXXXXX.YXXXXX
artQ will be substantially completed approximately on %�X'XXXXXXX,%XXXXXXXX,XXXXX , subject to delays caused by acts of God, stormy weather, uncontrollable
labor trouble, or unforeseen contingencies.
Any alteration or deviation from the above specifications, including but not limited to any such alteration or deviation involving additional material and/or labor costs, will be
executed only upon a written order for same..signed by Owner and Coldraeter,.and'it there is any charge for such alteration or deviation, the additional charge will be added to
the contract price of this contract.
If any payment is not made when due. Contractor may suspend work an the job until such time as all payments due have been made. A failure to make payment for a period
in excess of 0 days from the due date shall be deemed a material breach of this contract.
Respectfully submitted.
-RUSEN JV. VASQUEZ
wa,dor
By 47-2'- -co
4.5-020 ELM' ST.
sum AOerest
Name and Registration No. of any Salesperson who solicited or negotlated this I NDIO, CA, 92201 347-5631--( )
contract: My sm Lp Twaions NO
No. 456498 _
Celnreero *$, srm Law No.
ACCEPTANCE
You are hereby authorized to furnish all materials and labor required to complete the work mentioned in this Proposal, for which I/we
agree to pay the contract price mentioned in this Proposal, and according to the.terms thereof. I/we have read and agree to the provisions
contained herein, and in anyattachments hereto, which are made a part hereof and are described as
owners come
SUM ApMess
Lar sun 210
ACCEPTED:
(owmrs S-Ormure) IOs1e1
Contractors are required by law to be licensed and regulated by
the Contractors' State Ucense Board. Any questions concerning
a contractor may be referred to the Registrar, Contractors' State
Ucense Board, P.O. Box 26000, Sacramento, CA 95826
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9usims Adores ButJness Mone w.