0207-178 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
:D th License # Lic. Class Exp. Date
L 62.5038 C39
ZO r- /Date ')A' ) ' Signature of Contractor
J U 0 OWNER -BUILDER DECLARATION
H WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
a Z WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
U-)
F2 O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
0 � Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
d 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
it 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier -ST.ATr!, pfj)gD Policy No. A02020?
ao �
�0
J (This section need not be completed if the permit valuation is for $100.00 or less).
(0. 1 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 fort with comply with those provisions.
Date: & Applicant ' r' f- �? . �f eb,. "'Z N • �*'f
r~ V
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
44
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree .to comply with all City, and State laws relating to the building
construction,• end hereby authorize representatives of this City to enter upon
the above-mia itioned•property for inspection purposes. #f
Signature I(Own(WAgent) Date 4foB?
BUILDING PERMIT PERMIT# - -
tY1:t3T-�.�
DATE`07� VALUATION Y LOT TRACT
JOB SITE
ADDRESS .1 Ci i�
APN 774-125-0222
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TIMMY L 8��`l9?F0RD JTk
Cil«')TOM ]Et00MG CO.
535Z'z ', L�Nf �� Dr.
38-980 i� XC' Q1,03 COYOTES
LAQUIM& CA, 9 253
11 IX0 Chi 92203
(760';345-3751 CBL# i2
USE OF PERMIT {
ommiALi3uw. wo
k&iZC OF/CLMS A st3'KfZP'.LAL1 ONLY, �
I
REIROOF 4M.00 L8
PEMIT fbrWE i' �M.%�1.'Aa4,Y
MOOF FER, I CZ w{3f9i7-�18' t�0{3 ��0000
j --upprow, isa�l'$.�yui naw Aw Pi Air (':�'�.�'J�:✓'Y.t-,
SII �r °�'a
$10-00U
0.00
a 6"w" urs �3�
•'.
I; GAJ. IA'1LW.. Fn Its D1TE Now
V0.00
a
4UQ
CIiYOFLAQUINTA i,
FINANCE DEPT.
RECEIPT
DATE j %
,BY.--
DATE FINALED
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 , y S O Y
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
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
6.—
CUSTOM ROOFING COMPANY
38-980 RANCHO LOS COYOTES
INDIO CA 92203
PHONE: (760) 345-3751
DATE: July 24, 2002
TO: Mr. Sandiford
53-521 Eisenhower Dr.
La Quinta, CA 92253
CA LIC. NO. 625038 PROPOSAL NO. 53 -SAN -521-02
SHEET NO. 1
PROPOSAL AND CONTRACT
PHONE: (
. FAX:
JOB ADDRESS: 53-521 Eisenhower Dr.
La Quinta, CA
SPECIFICATION AND UNDERSTANDING: Tear off existing roof and re -roof as follows: Nail down 1 layer base sheet
to roof deck. Install new metal on edges. Install 2 layers fiberglass felt, hot mop between layers. Apply small crush rock and coat
white. Custom Roofing Company to remove all roofing debris from property.
SPECIAL INSTRUCTIONS AND NOTES: (1). A deposit may be required to cover the cost of material. Draws on
balance due may be required. (2). Any sheeting needed will be an extra charge of $30.00 per sheet above contract price. (3). Any air
conditioners, water coolers, duct work, electrical, etc., that needs unhooked, moved, or removed or unhooked from the roof will be the
owner's responsibility above contract price. Custom Roofing Company not responsible for damaged air conditioners, water pipes,
ductwork, electrical, etc. that may occur if, owner has not had them removed or unhooked from the roof prior to Custom Roofing
Company starting the job. Any drains that need replaced or installed will be anextra charge above contract price. (4) Any insulation
need will be extra.
TOTAL COST: $5,700.00 (Five Thousand Seven Hundred Dollars.)
TERMS: TO BE PAID IN FULL ON COMPLETION UNLESS OTHERWISE SPECIFIED IN THE CONTRACT.
FIVE (5) YEAR guarantee against leaks on Custom Roofing Company's work only.
NOTE. BECAUSE OF THE RAPID RISE IN THE COST OF MATERIAL THIS PROPOSAL WILL BE NULL AND VOID
AFTER 1 S DAYS. JOB TO BE STARTED INA TIMELYMANNER ACCORDING TO SCHEDULE AND WEATHER CONDITIONS.
IN KEEPING WITH INDUSTRY STANDARDS: (1). This guarantee does not cover any damage to the interior or
exterior on which the roof is applied or damage to any contents therein. This guarantee does not cover any damage to roof due to any
cause beyond our control including, but not limited to, fire, lightning, windstorm, hailstorm, rainstorm, installation of antennas, or
other equipment, foot traffic on roof, structural fault or settlement, cracking or other failure of roof deck, walls or foundations 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 any additional charge is made for such work, customer
understands that neither Custom Roofing Company, nor installer assumes any responsibility for the performance of said equipment.
(3). Custom Roofing Company does not assume any responsibility for existing code violations or for the installation of any existing
defects unless specified in the estimate and proposal.
ACCEPTANCE: You are hereby authorized to famish all contents written in this contract to complete the work mentioned
in the.proposal and contract for which Uwe agree to pay the amount mentioned in said proposal and according to the terms thereof
IN KEEPING WTM INDUSTRY STANDARDS: It is understood that by the acceptance of this proposal you authorize
Custom Roofing Company to make the installation, to -issue work order with specifications shown herein and to pay our charge for
such installation. You agree to pay Custom Roofing Company�the amount specified herein, which will cover the price of said
materials.and•labor,gharges.. This estimate is based on complete job and any surplus material remains the property of Custom Roofing
Company. Verbal understanding and agreements with representatives shall not be binding unless set forth herein. There shall b�'iio
liabilities for delays in,,or failure to complete, deliver or installation of all or` any of the herein mentioned merchandise; if'due'fo $i'e;
strikes, war, governmental regulations, or any cause beyond.our. control. Any changes made by you in specificafions•liecem" ,
necessitating additional materials or labor shall not be included or covered for by this proposal, but shall be provided for under"a"
separate and additional order from you.
OWNER'S SIGNATURE: DATE:
CONTRACTORS SIGNATURE: DATE:
(PLEASE SEE OTHER SIDE)
NOTICE TO OWNER
Under the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier or other persons who helps to
improve your property but is not paid for his/her work or supplies, has a right to enforce a claim against your property. This means
that after a court hearing your property could be sold by a court officer and the proceeds of the sale used to satisfy the indebtedness.
This can happen even if you have paid your contractor in full if the subcontractors, laborers, or suppliers remain unpaid.
To preserve their right to file a claim or lien against your property, certain claimants such as subcontractors or material
suppliers are required to provide you with a document entitled "Preliminary Notice." Original (or prime) contractors and laborers for
wages do not have to provide this notice. A Preliminary Notice is not a lien against your property. Its purpose is to notify you of
persons who may have a right to file a lien against your property if they are not paid. (Generally, the maximum time allowed for filing
a claim or lien against your property is ninety (90) days after completion of your project.)
TO INSURE EXTRA PROTECTION FOR YOURSELFAND YOUR PROPERTY, YOU MAY WISH TO TAKE ONE OR
MORE OF THE FOLLOWING STEPS:
1. Require that your contractor supply you with a payment and performance bond (not a license bond), which provides that
the bonding company will either complete the projector pay damages up to the amount of the bond. This payment and performance
bond as well as a copy of the construction contract should be filed with the county recorder for your fiarther protection.
2. Require that payment be made directly to subcontractors and material suppliers through a joint control. Any joint control
agreement should include the addendum approved by the registrar of contractors.
3. Have joint checks for payment, made out to both your contractor and subcontractor or material suppliers involved in the
project. This will help to insure that all persons due payment are actually paid.
4. After making payment on any completed phase of the project, and before making any further payments, require your
contractor to provide you with unconditional lien releases signed by each material supplier, subcontractor and laborer involved in that
portion of the work for whicb payment was made. On projects involving improvements to a single-family residence or a duplex owned
by individuals, the persons signing these releases lose the right to file a claim against your property. In other types of construction this
protection may still be important, but may no be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU MUST BE
CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE SIGNED.
BUYER'S RIGHT TO CANCEL
You may cancel the agreement or the offered referred to on the front at any time prior to midnight of the third day (excluding
Sunday) after the day you signed the agreement or offer. If you cancel and you have already made some payment to the seller, the
seller is entitled to retain out of the payment, as a cancellation fee, five (5) percent of the cash price of the goods or services, but in no
event may the seller retain more than fifteen dollars($15.00).
You may give notice of cancellation by mailing a signed and dated statement to the seller at the address indicated. In order to
have proof of the mailing, it is recommended that you mail the statement by registered or certified mail. If you do so, you should keep
the slip the post office gives you.
APPLICABLE LAW
This agreement and all the rights and obligations of the parties under this Agreement, shall be governed by the State of
California.
CONSEQUENTIAL DAMAGES
Buyer shall not be entitled to recover any incidental or consequential damages as that term is defined in Commercial Code
Section 2715.
ATTORNEY'S FEES
In the event of litigation arising out of this agreement, or the performance or interpretation thereof the court will award
reasonable attorney's fees to the prevailing party.
NO OTHER AGREEMENT
This agreement is the full and final Agreement of the parties, and no oral communication between the parties before the
execution of this Agreement will modify or amend the Agreement. The Agreement may be modified only by written document signed
by both parties.
LIQUIDATED DAMAGES (1 112 % PER MONTH SERVICE CHARGE)
In the event of a breach of the payment terms of this agreement It is agreed that the sellers
(contractors/subcontractor/suppliers) actual damages caused by such a breach are difficult and impractical to determine and
include, among other things, administrative cost for billing, accounting for and collection of past due payments as well as the cost
to seller of the amounts past due. Accordingly, buyer agrees to pay seller liquidated damages as delinquency/service charges on all
accounts past due at a rate of I and 112 % (I U2 percent) per month until paid This is agreed to be a reasonable method for
fixing seller's damages so arising.