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9809-004 (RR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I'am licensed under provisions of Chwater 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 691270 C-19 VDate ' (" t � Signature of Contractor 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, 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 Policy No. ST/VUE FLM, M-1741-98 (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 sweet to the workers' compensation provisions of Section 700' of the Labor �C de, I shall forthwith comply-with,those°provisi° % . te: ` -tea➢ 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 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 authorizer representatives of this City to enter Upon the above mentioned property for inspection purposes. t ignature (Owner/Agent) -� Date t'"� BUILDINGPERMIT PERMIT# CONTROL# DATE 91 /98 VALUATION S2,V90 Q0 LOT TRACT 81®1 r .i. ADDRESS 5:,445 AVENIDA ��1L6.r� JOB SITE APN 773-273-049 OWNER CONTRACTOR / DESIGNER / ENGINEER / j DA.lU;tL1 V&C1lls'.1'i'NE�joc)RE BU1tiid7f. ,fmc. ( 52445 AVENWA W:,1:;A. ' 51435'VIA LA PALNIM Lc QUINTA CA 922_53: 'i° IOUSAND PA.i. MS t CA 92276 (760)341-7555 ! C13I.X 3583 j dSE OF PERMIT 00N.r R.AL BUILDING 41 tJi-ROOF - saDMOVE EXISTING UWL1-UP ROOFINGAND R[3':LACF, MATIT COMPOSITION SN.f.rvCeLEA CONTRACT AMOUM 2,891.00 LS ` STIAa� U'u1) COST O COINISTRIUCTION 2,0 1.C,0 PERMIT FE -'E SUMMARY ?"0t:+.h ME 161-000-4184t1Q 0.( S -'?101 A l= r.0N grf? UCT1()N LESS M -PAID PEES X0.00 DA ® $30A)o S F P 01 1999 ' RECEIPT°`A Q F I D LA j 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 Roof Deck O.K to Wrap _ �% ( ( Combustion Air Exhaust Fans 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 BLOCKWAL AP ROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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 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) I. BUNDE RO S INC P.O. JM, NW6 (76. ,S Dan Moore •52-445 Ave. Villa' La Quinta, CA,92253 Re: Re -roof Dimensional Shingles., For the Sum: $ 2,891.00 We propose to furnish and 'alip1Y the following: Tear off,existing tar and gravel roof and haul away. Inspect sheathing for dry -rot, and replace any damaged wood on time and material basis. Install new metal trim around perimeter as needed.. Re -roof with one layer #15 felt nailed to -hold in place. Over felt install new 25'year self sealing dimensional shingles to manufactures specifications. Install individual units on all hips ani ridges to compliment new roof. Paint all flashings with rust proof paint. Replace broken tile.'Haul away all.debris caused from above work, and leave area clean. Any,questions regarding this estimate, please feel free to call. A five ,year guarantee ,will be in effect upon payment .in full. TERMS: 100% UPON COMPLETION, UNLESS OTHER ARRANGEMENTS HAVE',BEEN MADE. THIS ESTIMATE IS GOOD FOR 15 DAYS FROM -DATE BELOW. IT IS HEREBY AGREED BY •BUNDE ROOFING & ASSOCIATES.INC.' AND THE OWNER THAT WE THE CONTRACTOR, SHALL NOT BE LIABLE FOR ANY OF'THE FOLLOWING: DIRT, ROCK, OR ANY DEBRIS THAT MAY FALL BETWEEN THE SHEATHING BOARDS ONTO LIVING AREA. DAMAGES TO ANY CEILING MOUNTED FIXTURES', VENT AND / -OR CONDUIT PIPES STRUCTURAL DEFECTS IN BUILDING."IT WILL BE OWNER'S .:..'RESPONSIBILITY TO REMOVE AND REPLACE ANY ROOF MOUNTED ANTENNAS AND/OR SOLAR PANELS. IF THE SERVICES OF AN ATTORNEY MUST BE'EMPLOYED TO ENFORCE COLLECTION, THE OWNER AGREES TO PAY ANY ATTORNEY AND/OR COURT COSTS.' CONTRACTOR'S ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED -BY THE,. CONTRACTOR'S STATE LICENSE BOARD. 1020 N'STREET SACRAMENTO,•CA 95814" LICENSE # 691270 RESPECTFULLY SUBMITTED BY: DATE:08/12/98 t ACCEPTED BY: l' l/v -- DATE: ev ew o v �. p 1.',�c s � o % 100 po- 02<o vL %�er- We- 46e ' 1