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LICENSED CONTRACTOR DECLARATION
I hereby 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
61.54515 C.19 351197
pate 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
tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued.. My workers' compensation insurance carrier,-,& licy no. are:
Carrier i rti..t.c5 r ,e�vv Policy No. ; �° ,?��i
BUILDING PERMIT PERMIT# CONTROL#
�b �> "' 41016
DATE 9/ 9/96 VALUATION $2,1)00.01)LOT . TRACT
JOB SITE APN
ADDRESS 524 HE1; RERA
OWNER CONTRACTOR / DESIGNER / ENGINEER
52-63(3.11H,RI EKE 834W AVE 45 iff
LA. QUIN1:A CA 02253 IND CA 9220.1
19),75-.54 17_ C°IALO .1.925
USE OF PERMIT
t 9?AjMAL i3Ui"I., INO
iQF FC+,7t.?k7 .
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i�:,�v'D'ri;�.el,"r'��.f i;%���' pit++' i�(DIV�'IC'E:;i�`1�`'d•it):r` .
(This section need not be completed if the permit valuation is for $100.00 or less).
fCC?M1 lf)}-(ri)t) 4111-ii4)(! $30)0
() 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 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.
/ RECE
Signature (Owner/Agent—"'.—. Date
2,000.00
SUB-IMAL CONSMlCY10NI AND PLANT CHECK $30.00
LESS PRE -PAID FETS $0.00
'1'OU1, PEAKIT Ii'CES lbU , NOW �;911,t111
DAA_ IINSPECTOR
BY }dry' fes/ I DATE FINALED I .
-..._.._----�'-J."-_. � ----- /?.--=�...�---IIs----------•-- '- - -
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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)
T:
PRO -TECH ROOFING COMPANY
78-670 HWY 111 STE 0185
LA OUINTA, CA 92253
( 619 ) 775-5477
(619) 775-5479 FAX f�R�PaSA�
aaaaa��aaaa�
NUMBER : S--342
SHEET NO:01
DATE: 8--
(619)
-'
LICENSE 0-615515
Proposal Submitted To: Work To Be Performed At:
GARY EVERSON 52-600 AVE HERRERA
LAQUINTA CA ^ LAQUINTA CA
-
-5;3k-(0%0
. ----------
We hereby propose to furnish the materials and perform the f_labor _necessary for
the completion of: REROOF W/ O
25 YEAR SHINGLES ,A �.)I�J?
1. REMOVE EXCISTING ROOF TO SHEETING, REPLACE NECESSARY PLYWOOD @ $35 PER.
2. INSTALL NEW EDGE METAL NAILED TO SHEETING.
3. INSTALL 1PLY #30 LBS FELY NAILED TO SHEETING.
4. INSTALL 25 YEAR SHINGLES AS PER SPEC.'
5. CLEAN UP JOB.
6. NOTE TILE SECTION IS ALSO IN NEED OF REROOFING, PLEASE CONSIDER REROOFING
THIS AREA AS WELL, I SEPERATED THE PRICE.
4 YEAR WARRANTY
A(\ material is guaranteed to be as specified, and the above work to be
performed in accordance with the.drawings and specifications.submitted for the
above described work and complete in a substantial workmanlike manner for the
sum of-- $2,640.00 UPON COMPLETION
Any alteration or deviation froe the above specifications involving extra
costs, will be executed only upon written orders, and will becose. an extra
charge over and above the estisate. All agreelents are contingent upon strikes
accidents or other delays beyond our control. Owner to carry fire, tornado
and all other necessary insurance upon the above work. Norksan's Coopensation
and Public liability Insurance on above work is to be provided by:
PRO—TECH ROOFING COMPANY Respectfully Submitted
David Krastel, Operator
i ACCEPTANCE OF PROPOSAL
i
THE ABOVE PRICES. SPECIF A ONS AND C IONS ARE SATISFACTORY AND ARE
HEREBY ACCEPTED. YOU.ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL
BE MADE AS OUTLINED ABOVE.
Date:
Signature
Signature
Any controversy or claim arising out of or relating to this contract, or the
ich thereof, shall be settled by -arbitration in accordance with the Uniform
Rules for Better Business Bureau Arbitration, and the judgement upon the award
randered by the Arbitrators) may be entered in any Court having jurisdiction
thereof.