0104-078 (RR)LICENSED CONTRACTOR DECLARATION
rlhereby ?ffirm under penalty of perjury that I am licensed under provisions of.
L'hapte* (commencing with Section 7000) of Division 3 of the Business ands
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
%71988 O x.'.39 06MO(
Date [ 1 ;r , Si%gnature of Contractor-^ 77
OWNER -BUILDER DECLARATIVN
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:
Cartier Policy No.
,J1'JVf'P_VU',14-D 004001935191
(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 spall forthwith comply with those provisions.
Date: I t ... _ 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 IGovs relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)'. t� � y t a Date I. �► r It,(
1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 010 078 TRACT
&I —M KISIM
OWNER
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USE OF PERMIT
MNERAL BUIMI d(3
APN
FOAM uMIM
77530 SY:.3sf 2aQ21 PALM PO
1MT
CA 92 ,11,53 LA QUINTA CA +:2253
(160)360-5405 461
tcfr=1��30 F2,� 031 Uitt✓T'xl,d NS K)AWi
CLAOS A ONLY
VALUATION
UAOOF ME 103-000-418-000 $313,00
Q 2Ei�E. hCYYAL
LAPR 2001
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT IDATE
RUCTION AND 111" C,%TF 5,.K.
LESP, Fid-P,AU PETH&I
L F.t'JLWrFMS DUE NOW
1
BY I DATE IINALEDI _ _ I INSPECTOR
2,5 76.00
�f,J.C71?
61.39100
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 4 --Exhaust
Combustion Air
Fans
0. 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 �'/�• O (�
BLOCKWALL APPROVALS
Final
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:
"dM Aas-ters.
America's #1 Choice in Urethane Foam Roofing
50-865 Calle Quito
La Quinta CA 92253
760/360-5405 0 760/771-5638 fax
www.foanmnmtersrooftg.com
CUSTOMER
JOB ADDRESS
LA QUINTA STUDIO/GALLERY SAME
51230 EISENHOWER DR.
LA QUINTA, CA 92253
771-6700/774-5574 cell
JOSEPH ROUNAGHI
PROPOSAL/
CONTRACT
Date 3/23/01
CA Lic. #779820 C-39
SQ FT CODE TYPE COVERING LAYERS DESCRIPTION
1120 SLOPED TAR &'GRAVEL -1- RE -ROOF
VAC TEAR -OFF DUMP PWR WASH LIFT A/C A/C PLAT FLASHING EDGE METAL SIZE
YES I NO I YES I NO I NO I NO I NO NO
NUMBER of COATS COLOR GRANULES COLOR BLISTER REPAIRS 4'X8' SHEETING
-2- 1 WHT I NO I N/A I NO NO
TERMS: 10% DOWN / BALANCE PAID UPON COMPLETION
Unless specified slope of roof will remain unchanged Loose gravel and dirt will be swept from roof,
secured gravel shall remain. All okbris will be removed from premises unless otherwise advised AWall
"Changes" or discoveries difjeringfrom specifications included in this Contract may incur additional costs.
"Changes" to be paid upon completion of "Change". Completion of the roofing application will be affected
by weather conditions such as rain and wind Foam Masters can not guarantee removal of all water
standing on flat roof areas unless specified Roof must conform to 1994 Uniform Building Codes
concerning adeauate drainage. All new edge metal to be installed unpainted unless otherwise specified
5 -YEAR NO LEAK WARRANTY*
Foran Masters warrants to the Building Owner (current and future) that subject to the provisions of this document,
Foam Masters wN, at its awn cgwx e; make or cause to be made all repairs necessary to maintain the roofing system
in a watertight condition during the five year warranty period following the date of completion of the roofing system.
System In urdd. MembraneslT de installed by Foam Masters, Flashings (except metal or components not included by
Foam Masters as part of its specified roof system), Fasteners and Adhesives. Limitations: Foam Masters liability
under this Warranty shall be limited to the Owner's original cost of the installed roof system and only if leakage is
caused by defects in materials andlor workmanship. Erdasians: Damage to any part of the building (other than the
roof system), Damage resulting from: Repairs or work performed on or near the roof without Foam Masters prior
authorization. Damage from settlement, expansion, contraction, warping, or movement of the roof deck, walls,
structural members or building foundation. Natural disasters (fire, windstorm, hail, lightning earthquake, etc.). New
installations on, through or adjacent to the roof system withqui Foam Masters approval. Uncontrollable events. Lack
of positive drainage. Misuse or abuse of roof, improper roof traffic. Failure of materials installed by others (except
specified roof system)
* Repairs Dirty are ezduded front die 5- Year Warranty and are provi&d with a 1- Year Warranty on repair areas
only (repairs are considered gwcOc isolated points w*Nn a greater roof area). *10 -Year Warranty when spec fled
SYSTEM #9 ICBO # 4630 or ER -5289 UL # R10185
SCOPE OF PROJECT: AD work will be completed in accordance with Manufacturer Specifications.
REMOVE GRAVEL AND DIRT / INSTALL URETHANE FOAM ROOF SYSTEM
TO INCLUDE: Remove all loose gravel and dirt from roof surface. Apply
neoprene primer to roof surface. Spray I" RT2031 Urethane Foam to roof. -Apply 2
applications Permax 108 Acrylic Elastomeric Coating System at 3 gals. per 100 sq. ft.
NOTE: Ductwork not included in Proposal Cost. A/C duct flashings need to be raised
prior to job start.