9511-006 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 3520()7 C39 11/30195
Pcense # Lic. Class Exp.. Date
Xr
Date / (- 0 Signatureof Contractor � = O r'
OWNER -BUILDER DECLARATION
I hereby affirm 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, Business & 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
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 ST'ATP FUND Policy No. 48535395
(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
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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property fort nspecti- n pur 'bses..
C
f Signature (Owner/Agent) Dais
ALC0
..BUILDING
PERMIT
PERM IT�f5I1_4j06
DATE r, "
VALUATION
LOT
TRACT
JOB SITE ADDRESS 53,35 AIVE. 'VILLA
APN
OWNER
'CONTRACTOR
C' , 1Lt,')(Q$'l�iG
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P.O. BOX 396
INDIO CA 92201
tTIOUSANI D PAMN CA 92376
(019,298-1180 CIA,# 319
(619)3J3-1491
DESIGNER/ENGINEER
USE OF PERMIT5.(Y�!
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DESCRIPTION] �
FEES
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Y CONJ.1V15..1.'!]lv10VIV�I' 3,6W.00 L8
ES'i'lNVUEDCUS OF CONSTidUC'MIN'
3,600.€0
PERMIT ENE ;Sf)iY MI NI V
1RK,ROOE M 1,0).4M.418-000 $30,0
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e.,
SUB -TOT AL CONS"IRUCTION AND PLAN CHECK
$30.00
t.ESS :PRHt PAID It.IMN
$0.00
TMAE PERMIT FEE' 1)1J;4 NOW
$30.00
N'OTto.L PIT OJEFUl' PEWMIT FEES
30.00
RECEIPT
DATE
BY
DATE RNALED
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
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
E /
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:
C V ROOFING
P 0 BOX 1256
INVIO CA 92202
PHONE: (619) 398-5186
10, 1995
CA. LIC. NO. 352007 Proposal No: 1
Sheet:
Date: OCTOBER
To: BRETT ARKLEY Phone NO: (619) 343-1491
Address: P 0 BOX 396 THOUSAND PALMS CA 92276
Job: 53-355 AVE VILLA, LA OUINTA CA
SPECIFICATION AND UNDERSTANDING
Clean off existing roof and re -roof using new metal on edges, 1 layer base
sheet, 2 layers fiberglass felt, hot mopped, small crushed rock and coated
white. C V ROOFING responsible for clean up and removal of roofing debris from
property.
SPECIAL INSTRUCTIONS AND NOTES: (1.) Any sheeting needed will be an extra
charge of $30.00 per sheet above contract price. (2.) A'down payment may be
required to cover cost of material.
FIVE (5) year guarantee against leaks on C V Roofing work.
NOTES: IN KEEPING WITH INDUSTRY STANDARDS:
(1.) This guarantee does not cover any damage to the inter=or or exterior on
which the roof is applied or damage to any contents therein. This guarantee•
does not cover damage to roof due to any cause beyond our control including,
but not limited to, fire, lightning, windstorm, hailstorm, installation of
antennas or other equipment, foot traffic on roof, structural fault or
settlement, cracking or other failure of roof deck, walls or foundation 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 an additional charge is made for
such work, customer understands that neither C V ROOFING, nor installer
assumes any responsibility for the performance of said equipment.
(3.) C V ROOFING does not assume any responsibility for existing code
violations or°for the repair of any existing defects unless specified in
estimate and proposal.
TOTAL COST $3,600.00 PLUS COST OF SHEETING IF NEEDED.
TERMS: PAID ON COMPLETION OF WORK DONE BY C V ROOFING UNLESS OTHERWISE
SPECIFIED IN THE CONTRACT.
If not accepted within thirty (30) days this proposal is Trull and void.
JOB TO BE STARTED IN A TIMELY MANNER ACCORDING TO SCHEDULE AND WEATHER
CONDITIONS.
ACCEPTANCE: You are hereby authorized to furnish all contents written in
contract to complete 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.
INSTALLATION: It is understood that by the acceptance of this proposal you
authorize C V ROOFING to.make the installation, to issue work order with
specifications shown herein and to pay our charge for such installation. You
agree to pay C V ROOFING the amount specified herein, which will cover the
price of said materials and labor charges. This estimate is based on complete
job and any surplus material remains the property of C V ROOFING. Verbal
understanding-and,agreements with representatives shall not be binding.unless
set forth herein. There shall be no liabilities f -or 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
by this proposal, but shall be provided for under separate and additional
order from you.
OWNER'S SIGNA'
CONTRACTOR'S SIGNA'
ease se�`e ncltice on back)
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