0101-221 (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
t ' � • �,r}
Date—,§ignature of Contractor
OWNER -BUILDER DECLARAT(10_ N
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&RC. fcr 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:
Carrier i Policy No.
(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 cf•'Sc ;tion 3700 of the Labor
Code, I shall forthwith comply with thosd pfn isid6s.
Date: Applicant_- _
Warming: 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 I•epresentaflves of this City to enter upon
the above -mentioned property for.lnspectfon,purposes.
Signature (Owner/Agent) �' r / Date f .`
BUILDING PERMIT PERMIT#
DATE VALUATION LOT iii;,i - TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
kA1 PH C;ARY,.A
R(XD!4 1 1.K
7 -W) CAA. J G }.Tf.GAFE
7 4.. 9 f* RUN AWAY BA DR.
LAQ1jJ11,Tf_k CA
bEKMU1)A1)7.1i3.S K,A. 92211
(761J)200- 0811 1,120
USE OF PERMIT
RAVROOV VX.RMIT 0NI.Y- MUST REPI"3, ROeai'[NO MATXRIAI- WIT!I S:I.A N
A FIR 11ATINO MAXRAIALONLY
}�i�I�r7C5i' S,5f10.f�3 iR
i
X11V1-1WTi1;T>' C087f OY Vi 3l'+161,RTf I
F0
PI':K.Mf1 1':W: R13>ir MAkY
0 103.000-4 18. 000
:ltFf."-'IY iFAL, ("C?NCt'!k::13CTi7(?t'1 ANL F'I.AN C'.I3E�F�tL
RECEIPT
DATE
i
BY
,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERA i ION DATE INSPECTOR I ❑PERATiON DATE ` !NSPECTOR
BUILDING APPROVALS I MECHANICAL APPROVALS
Sal Eacks I I LJr.dergrnund nu tg I
Fo"s & Foclir CS I 6—ucts -
Slab Q*aUe ! { i :Etm i Alt �—
slt-el i j { cmnim4s ian Air j - -
RG::li sc4r =-Alms! Fans
Frarrint _ ^C�rnpfessor ! �j
insufalfon—
Fireplace F-t-
Yllr:."."_ ti I'^ f'15 i L�r.
�3yf r.lf::''s — ]
POOLS - SrhS
I sl•u_i I
_ •f !.+.air- nr=i^ — —
..irl _ •L} �.. ,-`.?ti� isi_1, i LiC�'.:li
r':: c C Crtne r1iC. I ! L('.:• 3^5[lla J7r1
I — —
1 �
i
Fir�ai
L4;iity I''Ic�1re I;��y I 4
ELECTRf'C'AL APPROVAi_.-.
Tempt. Penver Pcle
Lime-Ti rti]md CCi}•3Lt[�
Rough Wong
L" Wage Wring
f
Fixtures
Main Service
Sub Panels
Exlei for Reaeplac^ -,.%
SumRe Detectors
Temp. LJse of Power - - -
Final
f Ullllly Plotlee (Perm)
till=f
f� r) P N T
S- 2 U 7
CONTRA£TQRSTEII�E 636394 P.O. BOX 11257
Q-7 2 I Palm Desert CA 92255
`760-341-6073
L$O-f60731�
A pwposal-submitted to;RAI PH-GARZA
MaiiinJP
c Address: P.O. BOX1874 LA-QUINTA, CA 927253
Job Address: 776I10- CAiLLE TE.CATE _LA QIIR A, CA 92Z53-
Phone: 564-7074
Description of Work to Be� Performed:
REMOVE EXISTING BUILT IJP ROOF AND -DISPOSE. NAIL ONE LAYER 40# TILE
L1NER REPLACE GALVANIZED FLASHING FOR RV A.C: AND -PLUMBING. INSTALL
NEWSHEET-METAL AT ALL ROOF TO WALL TRANSITIONS. MTALL TWENTY
li IVE SIUNGLES ARID A/C 1JN T TROMF'ACIA TO -BACK OF DUCT WORK FOR
SERVICE WORK. INSTALL LIGHT-WEXHF-ROOF 'FILE T-O-�JFACTURES SPECI-
FICATIONS. $8250.00-
PATIO--STET PATIO COVER WITH PLYWOOD- $- 500 00_
NAIL ONE -LAYER GLASS -BASE TOPR> PARED SUREACE, INSTALL. NEW EDGE
METAL AND -PRIMER. TORCH ONE LAYER-G13SP-4 MODIFIED $750.00
Notes_ItiKe-uciffi Tuciffi ndi�str�►, stanr)ardr L domxakcrrvzr-nyda<tnage2o.the interior Dreactie-
rior on which the roof.is applied or damage to any contents therein. This guarantee does not cover damage to
Tod -due to anzaamIxpmd cur:c►m�F_ inch bur rtnt tn: fiz�lig�iwindstorm, hailstorm, an-
tennas or other equipment, foot traffic on roof, structural fault or settlement, cracking or other failure of the roof
,-vmlkor.fmuidatitm -&the baddin&cn which the maaf is applied _ 11-Shmild-it.lewpome necessary for the roof-
ing contractor to remove and/or reinstall any antennas, cooling or heating appliances or other equipment, whether
sac not -an -a itional ismadefar mrhum krthe.msbmmrmWerstmcl-,-thatnei.ther Roof Tile Special �ror
the installer assumes any responsibility for the performance of said equipment. 3. Roof Tile Specialty does not
ass" �iie any TeSPINIEhifttY fm moons of f Yualations orfor-thz-r r of any existing defects un-
less specified in estimate and proposal.
Tindal-f'est SEE ABOVE- Terns paid an mmmktimvuwem r �:�a-sires �n the contract. If not accep-
tance in thirty days this proposal is invalid Extra $35.00 per sheet of plywood if needed
Acc4tmire Y* w ittmrin-thi. 1 io complete work mentioned
in the proposal contract for which Uwe agree to pay the amount mentioned, in said proposal, and according to
termsstbexeof, . (Imaal)- .If a }�; hT_im s v zithin TEN years.from
date of application, we will repair it free of charge.
Iustallatim--it-is:undmmnmdthat the-acceptai=&thi&pmpxsaLymr Tile Specialty to make the
installation: to issue work order with specifications shown herein and to pay our charge for such installation-
Y011-agEceo-PaY wftb:lrwdfix=.the4uicr_a£said materials and labor charge.
This estimate is based on a complete job and any surplus material remains property of Roof Tile Specialty. Verbal
under==-rdi ig_and.a widr -sbalr notbe-binding to bmt,.set li herein_ There shall be no
liabilities for delays in, or failure to complete, deliver or installation of all or any of the herein mentioned mer-
ci���icp if- due infiriTy strr=war,_goYer nagatafioni-.07anyca Wr.Cnntracr Any changes
made by you in specifications herein, necessitating additional materials or labor shall not be included or covered
by this.proposal}Pi&shaltbe pravtded-for = additionatorderfromyou. ( Initial).
Arbitration of disputes: Any controversy or claim arising out of or relating to this contract, or the breach thereof,
.shallbesettledbyafitmtorin_accordance with C=stn=6xnthxhmtry Arbitrator Rules of the
American Arbitration Association which are in effect at the time the demand for arbitration is filed A judgement
upon.the-, mmrcl remkred..bythearbitrator(s1 re-entered ittr court-havingprisdm4on thereof Any arbitration
award shall be subject to correction and/or vacation for the reasons stated in the code of civil Procedure. The ar-
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PROPOSAL:
flGf TILE SPECIALTY 74075 ASTER DR. PALM DESERT CA 92260 7050-341-6073
I
DATE;
ram: r
'MA=G ADDRESS;
OB ADDRESS; L.Lf -,• -,y t� �`. ff' �,�_� �,�� ��
BY:
OF WORK TO BE COMPLETED:
h
r
SPECLkL INSTRUCTIONS FOR WORK TO BE COMPLETED:
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ARRANiY? HOWMAN+Y EARS ? O WARRANTY
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