0312-265 (RR)LICENSED CONTRACTOR DECLARATION
+= I1Tereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7060) of Division 3 of the Business and
0 W Professionals Code, and my License is in full force and effect.
p c) License # Lic. Class Exp. Date
235717 -39 D WC C 1f4 317,.E
o.Z r ..,,Date =7 g' .Signature of Contractor /
0.
JI!_
m OWNER -BUILDER DECLARATION
H a I hereby affirm under penalty of perjury that I am exempt from the Contractor's
0) 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. Business & Professionals
Code).
CO () I am exempt under Section , B&P.C. for this reason
LO
N Date. Signature of Owner
O N
IL Q WORKER'S COMPENSATION DECLARATION
00 :Z. 1 hereby affirm under penalty of perjury one of the following declarations:
Lo H p O 1 have and will maintain a.certificate of consent to self -insure for workers'
X W ILL compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued_...;_
Q (� ( I have and will 'maintain workers' compensation insurance; as required by
U Q Se�on 3700 of the Labor Code, for the performance of the work for which this
d H permit is issued. My workers' compensation insurance carrier & policy no. are:
a0D Caner siA7'I I'�t.INI� Policy No. �5';ts24^Q3
rn U'
g (This sectionneed not_be completed if the permit valuation is for $100.00 or less).
O 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 .1 should become
subject to the workers' compensation provisions of Section 3 37,0° f the Labor Code,,Ishallforthwith,complywiththose,pro io s. //
,,/bate:, -P-, 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 authorize representatives oo his City to enter upon
the above-mentioned property for inspW. io pu�oses
Signature (Owner/Agent) Date 3
BUILDING"'PERMIT PERMIT
1031246� TRACT
DATE VALUATION LOT,
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jog slfE
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DDRE s 7>:-�?� . :�J W 3A L.A QTuIt 1'A.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PA'.l":U.".T.0 8,0223
WF Ii><d P.4t'I�TC_' PC7CtS;i2�C"v
7 8-'I?.5 kt.WI£'I DA IA (,- LU b -B A
3462 LA C—At d3?ANA W�'s,'.Y.
LA QUNTA CA 97253
PALM SPRI.NG0 CA 921262
C 'SIR .4293,
USEOPPERMIT ,
03?AE .11 BUILr)1WG
R&ROOF - REM0VF-R'.EP.As1At RKPLACI&T17Lt? CLA."I A MATERIALS ONIX
RER.00F Z3,9UnM Ls
P%'. UMT M., 9Cl'.�+ ARY
P-BR.00F FEE 101-000418-000 $30,00
SM -TOTAL AL C,OA M.` . ITCffON AND P1:" CEEM,
$30.00
:LF03 YORR-PATD FEE
$0.00
1 k'i�°t�fV.It°I' k�'�:3.r.'.i >13U.�:.!\iE)t�►'
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30 00.3
C(OA
�
-RECEIPT
DATE'r
BY ��o^�M w
DATE FINALED
INSPECTOR
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
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
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
OX 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
UndergroundConduit
Rough yViring
Low Voltage Wiring
Fixtures
Main Service:
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
l
L�
WESTERN PACIF'LC
Roofing Corporadon
Since 1949 Lic. #235717
December 16, 2003
Patrick Ross
78225 Hacienda La Quinta
La Quinta, CA 92253
RE: 78225 Hacienda La Quinta, La Quinta, CA 92253
Installation of new the underlayment.
Dear Mr. Ross:
Thank: you for the opportunity to inspect the rooting system on the above referenced property. Having
done so we are pleased to submit our recommendations and proposal for the installation of'new the
underlayment. The recommended scope of work and associated costs is:as follows:
GENERAL
Unless expressly stated to the contrary, the contractor shall be responsible forperforming the following
acts.
DESCRIPTION
A. The general, conditions of this standard construction contract shall form a part of these
specifications with the same. force and effort as though repeated herein.
B. The clontractor.shall furnish all labor, materials, equipment, permits, contractor's licenses and
insurance certifications to perform all operations required and: specified.. Thecontractor shall
provide labor and material customarily included in work of the'same nature to give a quality,
complete job.
C. If unexpected conditions are encountered during the work, and the conditions adversely affect:the
cost orprogress of the work, the contractor will notify the owner immediately, and the owner will
negotiatea change -order to resolve the unexpected condition..
D. The Contractor shall occupy; use,, and permit others to use the premises only for the, purpose of
completing the work to be performed under this contract with the Owner. The Contractor shall
not authorize or permit any other -person to use said premises for any purpose whatsoever,
Western Pacific is to be given all reasonable set-upand staging,areas..
E. Contractor's scope:ofwork shall not include the'identifimtion, detection, abatement,
encapsulation or removal of asbestos or'similar'hazardous substances including mold. If
Contractor encounters,any such products or materials .in the course of performing its work, or if
such hazardous materials are encountered by any other firm performing work.at the jobsite and
contractor determines that such;materials present a:hazard to its employees, contractor shall have
the right to discontinue its work and remove its employees from the jobsite until such products or
materials, and:any hazards, connected therewith, are. located and abated, encapsulated or removed,
or it is determined that no hazard exists ( as the case may require), and contractor shall
3462 La Campana Way • Palm Springs, CA 92262 • (760) 416-5877 • ,Fax (760) 320-8912
www.westpacroof:com • E-mail: wprcps@westpacroof com
1
�3
Patrick Ross
December 1.6, 2003
Page 2
receive an extension of time to complete its work hereunder and compensation for delays encountered
as a result of such situation and correction. With the possible existence of mold from pre-existing
conditions, Western Pacific roofing Corp. will not be held responsible for mold related claims
resultim, from mold detected at anv time in the future.
INSTALLATION OF TILE UNDERLAYMENT
A. Remove existing, the and set aside.
B. Install two (2) layers of 40 felt mechanically fastened.
C. Supply and install new primary and secondary roof jacks. (Where necessary)
D. Re -install existing tile.
E. Replace broken tiles as necessary
F. Install new tile as needed. (As close a match as.locally available)
FLAT ROOF AREA SURFACE PREPARATION
A.. Ex:sting gravel will be removed by vacuuming.
B. Damage sheathing will be replaced at an additional charge of $45.00 per sheet or portion thereof.
C. Install new perimeter edge metal. (Unpainted)
D. Prime entire roof surface with Neoprime primer.
INSTALLATION OF A POLYURETHANE FOAM AND COATING SYSTEM
X. Urethane foam insulation shall be spray -applied to a nominal thickness of I inch (plus or, minus
Only 3 lbs. density foam will be used in this application. Additional foam will be aded to
till the 'low spots and help minimize ponding. Some ponding will remain.
B. Coating shall be applied in a minimum of two separate coats.
I . The base coat shall be applied at a rate of 1.5 gallons per 100 square feet.
?: The'top:coarshall be applied at a rate of I.5 gallons per 100 square feet, yielding a total
system thickness of both coats of -12-24 Total Dry Mils.
Duri'he the final top coat application. size 1 1 granules will be embedded into the wet top
coat material at a rate of 50 pounds per 100 square -feet. Topcoat color to be Tan.
4. All foam is to be coated. Coating shalt extend up and over all foamed vent pipes and
terminating a minimum of 2 inches above the foam, creating a neat appearance, self -
terminating flashing.
WESTERN PACIFIC
ImR-flxd Corperadmi
sine 1949
FROM,: PATRICK '88 SHE I LPM `7
"+nt 8y': WESTEP.N R00c 1 eG CORP.;
v
Patrick t21»s
1)accmUcr 1,0.200.'
Page 3
CONTRACT AMOUNT: 523.500.00
PHONE NO. : 619 564 2372 1- - Dec. 15 2003 04:52PM. 01
760 320 89112; Dec •i&. 0.3 16:13,; Paqe 6!6
WARRANTY
A five (5) year lahar.and materials warranty will be issued upon completion of the,roofand final payment
i� rc�ciocJ.
PAYMENT TERNIS,
A 0000.00 despo'cit upun signiog.of the contract :'end the balance due upon completiota Invoice to 1*
paid within ten'(10) tiayx of receipt..
'111c price quoted has been cmtetured to reflect standards we assume arra mutually-desirud: quality
.installation, scrvicu reliability and long tens performance. The price may he subject to changu 15 days
from the.date of this proposal.
I'i you are in accordance with the conditions herein, please execute the agrt:cmcnt below and xturn'buth
copies to this. office. We will, in turn, sign them and return one copy to you. 'Thank you, for your
cooperation in exp dfling this contract foryour rooting needs.
NOTICE TO OWNER
Contractors are requimd by lAw rn he licensed and regulated by the Contrxctar's Slatc License hoard.
Any concerning a contowt ritay be referred to rhe Registrar,.. ontractor"State: License Board,
-4!.O. Dux 26ow), Sacramento, Californin 95826.
ACXNOw M:r-N1ENT: Qwner acknowledges that he has,read and ruccivcd a Ic; ibis copy of dt6
ngreemettt including all lcrms.and standard proviMons before any work is penormed and that he has read
aud.receive d a Inible copy of every other document chat owner has signed during this negotiation. Uwe
hereby ncknowlcdge under the penaltyof perjury that liwe am -'are die legal owners and am!are authorized
LO sign this contract as an agent of the: legal owner.
AC C RPTANCE- The above prices, specifications and conditions are satisfactory andnre hereby
tf aceapted, Vou are :iuthorii ed to do the work as specified. Payment will be as outlined above. You,
Ute buyer iitay cancel this transaction at any tiine prior to midnight of tete third business dray ,titer
the date: of this transuetion. Owner has theright cu require contractor to have a perl'urmancc mad puyutant
hoed at owner's �;xpeiise.
PA,LRIC=K ROSS WFSTE110 PACIFIC ROOFING. CORP.
Contractors License #235717
Authorized Agent A Ronald R. Winkle
_Project Munal;er
`ritle/Daw
w:KSTKUN VACInC. R001V1144: IIAS ME RIGHT -1`0 RESCIND -111.15 CONTRACT wrrlllN PlrTEFN DAVS OF
A(,cEr7ANc 0_ T14_lti .4,GREEM&NT IS N4T1' t3IND1]NC°t.NTiL ACCt:PrlU RV Tet[ ORCt(F �tn!tA(:Et►n � 1' A'1'
3462 1A CAM YANA WAY, PAI Nt.SYl(1NG&$-A 92WL NA (}IAN( 45, Ott ADnIT10'1S°T()'n11J.AGREEM YNT'
SHAM. EL E1+t- Ci WE UN'rtt 'KO_tiI'RRN,YA(�;JFF1C,%1ANA(;XMEN'r.
V1ANA(:1{!(S AE'CF.P1 AN<[:: ATE�_� we/T% 3
]PACIFIC
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