0103-107 (RR)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
40Y1519 0-39 1/2(
Pa Signature of Contractor %'� a e
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 Libor 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.
WfAM FUND
(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 shall forthwith comply with those provisions—
Date:
Date: , > . - Applicant �� "'�`� ,v : ; i a
�Y
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 uporif
the above-mentioned property for inspection purposes.
r/gent)Signature (OwneDate
1Cf`
,XILDING PERMIT PERMIT#
DATE VALUafiION LOT f��p_y jf^yY TRACT
n31 F"' .
JOB SITE/
ADDRESS
APN t'
►�
OWNER
CONTRACTOR / DESIGNER / EN INEER
a
za .t7 ritoOiwar md,
78-080 C.AJXS FWADO
640 WILLIAMS ROAD
7..r^i.Qtroi' A CA 922.53
PAI.MSMU4033 CA 92264
('i'tl'> )%!7.3393 CZAR 326
USE OF PERMIT
GEN MAL XMIUDING
I
, UPOOF ;r3trdl,TUP ta'8kt,ZRGI �A:48 P21,70 ROCK C &S A
.0 17 fYiS, f)fl 1,21
F.°sr�rwAm cohor oF CO.GbSlIf0.V+4.alBON
PY.RWrIffix SUMMARY
IER00F Ff '! 01.,000-r4l 8.000 $30,00
MAR 14 2001
✓47 ® 0- LA ;J gIIMMi
P�E?-PAM "311
210,00
A
RECEIPT
DATE f �`
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
I
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts I
Slab Grade
Return Air
Steel _
Roof Deck L Q (, 57
Combustion Air {
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing'
Compressor
Insulation
Vents I
Fireplace P.L.
Grills I
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
I
Exterior Lath
I
Drywall - Int. Lath
{
1
Final {
Final
I • POOLS - SPAS
BLOCKWALL APPROVALS
steel i
Set Backs
Electric Bond 1
Footings
Main Drain I
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test !
Electric Final f
A'Waste Lines
Heater Final i
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
:hover Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation I
Gas Piping
Gas Test
Appliances
I
Final
COMMENTS:
I
i
i
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
TempA)se of Power
Final
Utility Notice (Perm)
Llcenga19
M
Contractor:
Owner
CONTRACT PROPOSAL
Contractors are required by law to be
licensed and regulated by the Contractors'
State License Board. Any questions con -
DEW ROOFING, INC.
earning a contractor may be referred to the
registrar of the board whose address Is:
640 Williams Road - P. O. Box 914 Contractors' slate License Board
1020 "N" street
PALM SPRINGS, CALIFORNIA 92263 Sacramento, California 95814
Phone (760) 327-3393
Marvin Investments, Inc Address: 78-080 Calle Estado Suite 201, La Quinta, Ca. 92253
WE PROPOSE AND AGREE to furnish required labor and material for
Remove old roof & reroof flat section in front of building only
for the above named building using 1 la=rr glass have #78 nail an & hat mop 3 1altersglacc p)r Tv & rock
In accordance with submitted plans and specifications, for the sum of
Six Thousand Seventyfive Dnllars and nn/rents- ($ %, P 7 5�) Dollars
ALL PAYMENTS TO BE 100% ON COMPLETION UNLESS OTHERWISE SPECIFIED ABOVE.
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1181 at eeq.),
any contractor, subcontractor, laborer, supplier or other person who helps to Improve your
property but Is not paid for his 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 own contractor In lull, It the subcontractor, laborer, or supplier remains unpaid."
This agreement shall become binding only upon the Contractor's written acceptance hereof or upon the Contractor's commencing
performance and upon such acceptance or commencement of performance this shall constitute the entire contract and be binding upon the
parties hereto, there being no covenants, promises or agreements, written or oral, except as herein set forth.
III( further understood that:
(A) The Contractor shall not be responsible for damage or delay due to strikes, fires, accidents or other causes beyond his reasonable control.
(B) The proposal Is limited to days acceptance from date hereof.
(C) The Purchaser Is dealing with the Contractor as principal and that the Contractor Is not acting hereunder as the agent or representative
of any person, firm, or corporation.
Date
3/5/01
PRICE SUBJECT TO CHANGE AT ANY TIME TO REFLECT INCREASED MATERIAL PRICES.
accept the above proposal.
DEW ROOFING, INC.
By: Salesman
Approved by: n//
BUENA ENGINEERS, INC.
1731-A Witter Street
VENA, CALIFORNIA 93003
(805) 642.6727
TO
THE FOLLOWING WAS NOTED:
DATE T=
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7
PROJECTUk F-5)QJff- `✓� //fin/
LOCATION
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CONTRACTOR
OWNER
WEATHER
TEMP. o at AM
° at PM
PRESENT AT SITE
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SIGNED
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EXECUTIVE OFFICE BUILD ! N G
Offices From 150 Sq.. Ft.
FULL SECRETARIAL SERVICES AVAILABLE
DEVELOPER
Robert C.Monroe
CONTRACTOR
Rick Johnson
LEASING INFORMATION 564-1262
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