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BMCH2016-0112�a ,78'495 CALLE TAMP` LA QUINTA, CALIFORNIA 9e 25 3APR..1 9 6i MMU CITY QFLA QUINTA Application Number: BMCH2O16-0112 -� Property Address: •48141 VIA HERMOSA APN: 646100001 Application Description: JUDY WOHL / HVAC CHANGE OUT Property Zoning: Application Valuation: $12,579.00 Applicant: VIC'S AIR CONDITIONING INC P 0 BOX 215 THOUSAND PALMS, CA 92276 4 VOICE (760) 777-7125 FAX (760) 777-7011 Y DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT. Date: 4/19/2016 Owner: JUDY WOHL Contractor: VIC'S AIR CONDIT0NING INC P O BOX 215 THOUSAND PALM6; CA 92276 (760)343-5033 Llc. No.: 756658 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSAMN DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: C20 License No.: 756658 oft work for which this permit is issued. ,I have and will maintain workers' compensation insurance, as required by Date: Contractor:a� Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: OWNER -BUILDER DECLARATION Carrier: _ Polity Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of .he.work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject.to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I.should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers', compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. Contractor's State License Law.(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the Date: Applicant: !ice basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO , (� I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,00. IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION', DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, '(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements : APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT:'Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that . the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this applation is made, each person at whose (� I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employeesfor any act or omission related to fie work being performed under or the Contractors' State License Law.). following issuance of this permit. (_ ) I am exempt under Sec.. . B.&P.C. for this reason 2. Any permit issued as a result of this application becomes null and void if work is Date: IOwner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit.is issued (Sec. 3097, Civ. C.). Lender's Lender's Address: ' 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 county ordl nances and state laws relating to building construction, and hereby authorize representatives of this.city to enter upon the above-mentioned pLr�opperty for inspection purposes. Date: 4 ' I%(r Signature (Applicant or Agent): FINANCIAL ••i DESCRIPTIONS �E.,gg OUNT�� d QTY AMOUNTp" ' PAIDf ;PAID,,DATE w"`ACC� BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/19/16 4 $fr`�4+'_- I $t',s .r .. h r' w . r '`"%C t _, ¢ €z .`rr • t < `: LMETHODT{PAEBYs xr VIC'S AIR CONDITIONING INC DEBIT R14895 RSE. Total Paid for, BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 ;,��{.�`DESCRIPTIONE4 �y <ACCOUNT Y>, QTYw ';x�� AMOUNTNY ry ix# Pi41D �Y 'PAID DATE' :Y".i ._:::f,•.: s .-..°t¢1gi . .y.. «�,4 HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $72.52 4/19/16 PAIDBY>{ .`� g?�P `'�METHOD'�� s`'YRECEIP7#z� CHECK#� }� xCLTDBY VIC'S AIR CONDITIONING INC DEBIT R14895 RSE DESCRIPTION q a NT<sa� CCOU +; :? AMOUNT y, I PAID DATE _.. s . x s.�E'QN y .. cPAfU`I .. , , _ r HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $36.26 4/19/16 METHOD EIPT#� o- CHEGK# CLTs .r«v• �.aU,_E -�__. e��,:- .: .. �z ;REC DBY7 VIC'S AIR CONDITIONING INC . DEBIT R14895 RSE Total Paid for CHANGEOUT: $108.78 $108.78 e DESCRIPTION OWN ACCOUNT - > �"! Qllf 5 AMOUNTf"PAID GATE: X .._SFS.$ '�..%1+. 1M -SY -.,.ti:x ..ef. ., �.. PERMIT ISSUANCE 101-0000-42404 01 $91.85 $91.85 4/19/16 gf .�Y z5.'" "y1 ,� PAID BYE*° 'r % *' ✓ �iCo- 1 f .G :. � t• t w METHOD r * i- .%+Ek RECEIPT # CHECK #,"mV h•i CLTD BY x j+xrd t VIC'S AIR CONDITIONING INC DEBIT R14895 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 •TALS: $201.63 $201.63 7 t • t Description: -JUDY WOHL / HVAC CHANGE OUT Type: MECHANICAL Subtype:. Status: APPROVED Applied: 4/19/2016 RSE Approved: 4/19/2016 RSE Parcel No:.646100001 Site Address: 48141 VIA HERMOSA LA QUINTA,CA 92253 Subdivision: TR 20052-1 Block:, Lot: 1 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $12,579.00 Occupancy Type: Construction Type: Expired: ' No. Buildings: 0 No. Stories: 0 No. Unites: 0 P_.HONE Details: HVAC CHANGE OUT - 20.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY) CARBON. MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. , CHRONOLOGY • FINANCIAL INFORMATION Printed: Tuesday, April 19, 2016 3:22:35 PM 1 of 2 SYST1AAS CONTACTS NAME;TYPE k ;NAME.: - ADDRESSI rCITYr k57ATE 2IP.e,=" P_.HONE FAX: :EMAILix_ u h'h:Y s. ,�„ ;ra :r . . »� :{.. °, .; »:•a:'. _ a. . .. _, :u _ ,. •._r . . �,z _ .c I e wr ? -r.'K' ,z ` _ � APPLICANT VIC'S AIR CONDITIONING INC P 0 BOX 215 THOUSAND CA 92276 PALMS CONTRACTOR VIC'S AIR CONDITIONING INC P 0 BOX 215 THOUSAND CA 92276 . PALMS OWNER JUDY WOHL 10811 SAVONA RD LOS ANGELES CA 92253 • FINANCIAL INFORMATION Printed: Tuesday, April 19, 2016 3:22:35 PM 1 of 2 SYST1AAS ............. . . 7 7�7 7 '4QTY 77�� 777 777� 'j, �c ACCOUNT C ,METHOD I , I . . VIC'S AIR BSAS SB1473 FEE 101-0000-20306 . 0 $1.00 4/19/16 R1489S DE BIT RSE CONDITIONING INC Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.60 BSA: HVACCHANGEOUT- 101-0000-42402 0. $72.52 $72.52 4/19/16 R14895 DEBIT VIC'S AIR RSE SPLIT -SYSTEM CONDITIONING INC HVAC CHANGEOUT- 101-0000-42600 0 $36.26 $36,26 4/19/16 R14895 DEBIT VIC'S AIR IRSE SPLIT -'SYSTEM PC CONDITIONING INC Total Paid for CHANdEOuf:' $108.78 s108J8 VIC'S AIR MIT ISSUANCE PER E' 101-0000- 4240 1.8 $9 S $91.m 4/19/1 6 k-4895 1 DEBIT m RSE CONDITIONING INC —7 Total Paid for PERMIT ISSUANCE: $91.85 $91.85 . . . ... ....... ..... . . . TOTALS: $201.63 �i6l.63 INSPECTIONS. ED : DATE REVIEW TYPE;,' PREVIEWER T�I) DATE Ej'r.,,.DUEDA .--NOTES A;_7a:. ATEg -F BOND INFORMATION .. ... ..... ATTACHMENTS . .... .... .. Bin # City of La Qulnta ' Building 8r Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 �VVV— 201 b— I Building Permit Application and Tracking Sheet Project Address: �6_41 V C M `4 t' -W, M 05p Owner's Name'% TU y\ Wo H L A. P. Number: Address: Legal Description: City, ST, Zip: Contractor. Vi e"s Al Telephone: - Address: b Q bj� . 2,114 Project Description: C_' City, ST, Zip: ^I F'101AS4hdv% (m -S Telephone: -760- 3q — 503 3 State Lic. # : City Lie. #, Arch., Engr., Designer: City, ST, Zip:. Telephone: p :<:•;:;:::;::::;.:; :::: >:;:.:v.:;«>;; Construction Type: Occupancy: State Lie. #: Project type (circle one): Now Add'n Alter Repair. Demo Name of Contact Person: lq4 Gws Sq. Ft.: # Stories: # Units: Telephone *,of Contact Person: 76, D f,9?, O q ,? Estimated Value of Project: 12, APPLICANT: DO NOT WRITE RF1_OW THIS 1 INF !! Submittal Rcq'd Recd TRACKING PERAUT FEES. Plan Sets Plan Cluck submitted Item Amount Structural Calcs. Reviewed, ready.for corrections Plan Check Deposit Truss Calu. Called Contact Person Plan Check Balance, Titic 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrcclionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fecs " Total Permit Fees CERTIFICATE OF COMPLIANCE CFiR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D.. Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cuuling Minimum Required Now or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas All new Central split All new Less than or System 1 furnace heating AFUE 0.8 AC cooling SEER 20.5 Setback equal to 40 R-8 components components feet Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & MR -MCH -20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: <_ 15%, or <_ 10% leakage to outside, or seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct LeakagTesting requirements . do Air Flow MCH Refrigerant Cha}ge MECH 21 -Heating-only systems and Air Handler/Furnace changes not require verifica tion of -23 or -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH 20 OucbLeakage Testing requiremenEs. .0 N:N,. 11 11 111 ;: .,A d « 'M t f P; t NI" q ,t �.,--•r.'...:...� x.:, g,..:�. ....,.�..u: ate: .e_ .:-. r' f' - Z W., E. Entirely New or Complete Replacement Duct=Systenl, with or.without Equipment Changeout (Sections.150.2(b)Wiia;and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. r Registration Number: 216-A0135092A-000000000-0000 Registration Date/Time: 2016-04-12 08:46:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-12 08:46:29 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC) (Page 1 of 3 ) Project Name: Wohl I Date Prepared: 2016-04-12 A. General Information �.�.. CF111-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF1R-ALT-02 document for each dwelling unit. ` 01 Project Name Wohl 02 Date Prepared 2016-04-12 03 Project Location 48141 Via Hermosa 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Wohl 07 Zip Code 92253 08 Dwelling Unit Conditioned 2000 :4ls the SC _.. c _ Installing a Floor Area (ft2) ,: SC System Number of space conditioning CFA served 09 Climate Zone 15 30 (SC) systems in this dwelling 1 Identification or Location or Area by this SC unit. containing m B. Space Conditioning (SC) System Information g 01 02 06 07 OS 09 10 �.. ... y •4 ,i. :4ls the SC _.. c _ Installing a ,: SC System SC System CFA served -`' ,systL,m a r f ige ar nt i.'Installing ew SCS Installing I ialIi g Installing entirely Identification or Location or Area by this SC ducted containing m system ore than 4 entirely w new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 whole house 2000 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater.Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. Registration Number: 216-A0135092A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time:,2016-04-12 08:46:04 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2016-04-12 08:46:29 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: / n 1 Victoria, Blanca (anca fctoria Company: Signature Date: VIC'S AIR CONDITIONING INC 2016-04-12 08:46:04 Address: CEA/ HERS Certification Identification (if applicable): P O BOX 215 City/State/Zip: Phone: THOUSAND PALMS CA 92276 760-343-5033 Responsible Person's Declaration statement' I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate, of Compliance,is true.and correct. 2. 1 am eligible under Division 3 of the Busines's and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications materials components and manufactured devices for the building design or.system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 o the Califomi wCode of R guia4ons.4jF. .'ii?r ) k `{ k r "4- '.-��"i+ 4. The building design features or system design features identified onthis Certificate of Compliance are cons(stent with the information'provided on'otherapplicable compliance documents, worksheets, calculations, plans and specifications submitted to the er forcemer&agency for approval Illwith this building permit epplicatiori. : a _ r ie . -+ . 5.. I will ensure that a registered copy of thisCertific teso( Compliance st all be:made'ayailable with.:the building permit(s).issued for -the building, and made available:,tothe enforcement agency for, all applicable x• inspections. I understand that a registered copy of this Certificate of Compliance is -required to be, included with the, document ation the builder rovides to_the buildin owner at occupancy. :. - Responsible Designer Name: _ t—• ... = Responsible Designer Signature:. -•3 Victoria, Blanca Otanca'R tori, Company: Date Signed: VIC'S AIR CONDITIONING INC 2016-04-12 08:46:04 Address: License: P 0 BOX 215 756658 City/State/Zip: Phone: THOUSAND PALMS CA 92276 1760-343-5033 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0135092A-000000000-0000 Registration Date/Time: 2016-04-12 08:46:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 'Report Generated: 2016-04-12 08:46:29 Schema Version: 0.555SDD I Vic's,Air Conditioning Service LLC. P.O Box 215.Thousand Palm Ca 92276 72-774 ramon rd thousand palms ca 92276 760 3435033 service@vicsair.com Proposal Date Due Date Summary SP: Job Date 2777-2586 4/5/2016 4/5/2016 MAINTENANCE RENE 4/5/2016 Bill To: Job Name: JUDY WOHL TRUST- BRAD JACOBSON JUDY WOHL TRUS--BRAD JACOBSON 48141 VIA HERMOSA 48141 VIA HERMOSA LA QUINTA, CA 92253 LA QUINTA, CA 92253 We Hereby Submit Specifications and Estimates For: i SYSTEKTRANE CONDENSER- AC:XV20 - T4TTV0060A1000A COIL:ASPEN - . ACC60E44245L110 FURNANCE — UP —DOWN-HORIZ: XC80-TTUD2C100ACV52A j AHRI# 7181375 i OTHER: TONS.5 VOLTAGES: PAHSE: "`SEER: 20.5 ERR: 13 EXTENDED WARRANTY: CONDENSER: 10 year parts and 12 Compressor. ! COILS: 10 years parts FURNACE: 10 year parts and lifetime heat exchanger LABOR: 10 YEARS all inclusive (does not included refrigerant or maintenance) T -STAT MODEL: TRANE XL 950 71NCH TOUCH SCREEN THERMOSTAT TRANE CLEANEFFECTS ENERGY SAVING MAINTENANCE AGREEMENT: CRANE - SMALL OR LARGE: COMPRESSOR CHANGE OUTS ONLY: EXISTING UNIT MODEL# SERIAL# COMMENTS: NEW OUTSIDE ELECTRICAL DISCONNECT: X NEW AMPS SERVICE: NEW OUTDOOR CONDENSING UNIT PAD: X NEW PROPERLY SIZED REFRIGERANT LINES: REPLACED SUPPLY AIR REGISTERS: X 4= 8x8, 5=10x10', 1= 16x8, 1=12x8 I NEW GAS PIPING: ' NEW LOW VOLTAGE WIRING: NEW INSULTAGE RETURNED AIR PLENUM: MASTIC SEALING OR INSTALLED DUCTWORK: BALANCE AIR FLOW THROUGHOUT SYSTEM: INSTALLED MANUAL BALANCING DAMPERS: We propose hereby to furnish material and labor - complete in accordance with the above spec;fications, for the sum of: $0.00 i j i INSTALLERS ARRIVE ON TIMEX ! INSTALLERS COURTEOUS & PROFESSIONAL;X i MAINTAIN CLEAN WORK AREAS:X j REMOVE EXISTING EQUIPMENT:X RECYCLE EXISTING EQUIPMENT:X COMPLETE SYSTEM START-UP:X i 17 POINT SYSTEM PERFORMANCE CHECK:x j NOTES: j TAKE OUT OLD EQUIPMENT AND HAUL IT AWAY. INSTALL NEW CONDENSOR, NEW FURANACE AND NEW INDOOR COIL, WE WILL ALSO REPLACE THERMOSTAT. TRANE CLEANEFFECTS WILL ALSO BE INSTALLED. CAULK, AND INSTALL NEW SUPPLY VENTS. WE WILL SEAL ONE SUPPLY DUCT IN ATTIC THAT HAS THE INSULATION RAP TORN. CITY PERMITS INCLUDED, HERS TESTER IS NOT. j i WE PROPOSE HERBY TO FURNISH MATERIAL,` -LABOR -COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICTIONS FOR: THIRTEEN THOUSAND EIGHT HUNDRED SEVENTY NINE PAYMENT WILL BE MADE AS FOLLOWS: j CREDIT: FINANCING: CHECK: CASH: TRANE REBATE $1000.00 DOLLARS $13,879.00 DOWN PAYMENT $1,300.00 BALANCE $12,579 IID REBATE: $1000.00 EXTENDED WARRANTY: 10 YEARS LABOR, 10 PARTS, 12 YEARS COMPRESSOR($606.00) INCLUDED (AIR CLEANER) TRANE .CLEANEFFECTS : ($950.00) INCLUDED i i Exclusions: carpentry work, cutting, painting, drywall, line voltage, electric, low voltage conduit or disconnects, heating permits, combination furnace and water heater vents, trenching, grading or leveling, level roof platforms, draft stopping, fire stopping, fire dampers and structural strapping. We are not responsible to repair drywall, stucco, roof or any damage in the house when installing the unit. All material is guaranteed to be as specified. All work to be completed in a workman like manner according to the standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above estimate. All agreement contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by workman's compensation insurance. Note: this proposal may be withdrawn by us if not accepted within days acceptance of proposal the above price, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above i i i We propose hereby'to furnish material and labor - complete in accordance with the above specifications, for the sum of: $0.00 Authorized r Signature l Acceptance Signature ! ! Date i i i