0112-088 (RR)LICENSED CONTRACTOR DECLARATION
Cn I hereby affirm under penalty of perjury that I am licensed under provisions of
H 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.
O :D M License # Lic. Class Exp. Date
r` d LO
LU
oZ � Date Signature of Contractor;=��
(O 0
J U OWNER -BUILDER DECLARATION
W W ~ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d 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).
m () I am exempt under Section , B&P.C. for this reason
u7
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
p :E Z I hereby affirm under penalty of perjury one of the following declarations:
Cr
r � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W P- compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q () (,:) I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
,,I- Z Carrier Po'icy No. _
C3
J(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 pra ions. �r�r
Date: 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 laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above -mentioned property far Inspection purposes.
Signature (Owner/Agent) ! f Date r�
b GILDING PERMIT
PERMIT#
DATE VALUATION LOT
TRACT
JOB SITE
APN
ADDRESS
;�s-r1 -5 A VEI'1I' A IML i V(7 *
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R014ALD Aid. L1113RALTOH
DEW ROORHIG IN0
�3665 AVID DA V M A.21CC,
340 WII JANT 3?0.z,,L>
3:.1.Q1Iftr .A OA
PALM SPRINGS
CA 92264
(76Q)177.3393
CSIA 326
USE OF PERMIT
I? F.111'10F 3.11D140.t.X'S-C'LA NS A 4ATRAUAL 5
CITYOF
QUK A
lei J4AfyC
51PT
1... !.. 5.h•a.,�l. i�,fi +-.w ..'i.'
t''��_.. �.1�C 1', '' I.1
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:TU1:-Tt]"l AI (!,'_)k1'i3TRLTCq'10N ATE TD PLAN t'iiW-K
FRB-PAM FEL3
-.• �. .
x�----,�1XZS
RECEIPT
DATE , BY .
DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION DATE ih15PPCTOR
OPERATION I DATA INSPECTOR
BUILDING APPROVALS I
MECHANICAL APPROVALS
Sat Baas
Undargrcurd ❑Elvis
Forms Ps 1•"r4tln!o+
Duds
Slab Gmde
ReWFIF Aff
Steel
COi7rbuslw Air
tiG Sf fJ '}, 1
I
Exhaust F�{fy6
O.K. to Wmp
F.A.U.
I
rrd"nlCi�
Compressor
- -
Insulatl�+r
vEmis
_ —
-
!•ire},l3sn i�.L. �
rircp
Piwly Wal!_I�SIJIn!iR
GrUls
.�.
Fan, F. Con4re?s
Cam? darrnl _ Lh
--�
L
r' :fl � Po��r� I - — � -
tc
Equ.rrr--_rl Lnoal ari I�
Un'k.,.-uc 3n•_' i:IccIr,; I C
H
- Eaa;l n1r-t� "c:IG!u
_�;r 'or
Poo! Cr_'; [r I
=nca rdaliari
Final I
C 0 M m
!�
Eno upr Ld!!- j
BLOCKWALL APPROVALS
Ste• �,:: _ � — I— — �-
PLUNIBINIG APPROVALS
Waste Lh5r. i
RkIrfln';J lop 01i -�
- -
Si•lcsv, I�xn,
-J
I
Sewn.- {.aural ^I
Sever Cannru•ll•cn
I
Gas r IAlrti5-
Gas Tz51
I
Final
-
U?7ty Notice (Gas)
ELECTRICAL APPROVALS
Tamp. Pcwer Pole
Underground C(:nduR
Rough Wiring
Low Voltage Wiring
Fixtures
Main Se,vlrP.
I
-Sub PzmelF
F_x#encr ReLep; ]ns
G.F.I.
5mel:e Detectors
TgrnP Use of Power
I
I
Final
Ut7tty NOW(! (Perm)
Licensol,Nlo.409619 CONTRACT PROPOSAL
Contractors are raqufred by law to be
INC.14r;�Hcansed and regulaW by the Conlroclors'
DEW ROOFINGS I tate g a co a Board. ,ny refellong con.
red
e earning a cenlreetor me•. be referred to the
I }v� rrtplNrar of the board whole address Ie:
640 Williams Road - P. O. Box 914 Contractors' Stale Llcense board
7PALM SPRINGS, CALIFORNIA 92263 1020 "N" Street
,2�Seersmenlo, California 95814
Phone (760) 327-3393
Contractor: Address: 40-725 Meadow Lane, Palin Desert, CA 92260
Owner: Ron Hills h(cellular: 333-:2 1 Job Site: 53-665 Avenida Velasco, La Qujnta, Ga. _
WE PROPOSE AND AGREE to furnish required labor and materlal for Reroof HOUSE & GARAGE ONLY
ANY BAD SHEET W, DISCOVERED WILL BE RE[' AGED AT OWNERS' EXPENSE. NOT INCLUDED IN THIS BID!
for the above named building using 1 la r 30I1 Felt & 25-Year Fiberglass Shingles
in accordance with submitted plans and specifications, for the sum of
Three Thousand Four Hundred S-1,11 Five and no/cents.......3 475.00
........ ..
... ..... .... ..�(� )Dollars
PATIO:�Reroof using 1 layer Glass Base, 2 layersGlass Ply hot -mopped &72if GlassCap,.ADD $ 350.00
3 Year Guarantee ON WHATEVER WE REROOF.
IF YOU WISH THE WORK TO BE DONE, SIGN THE CONTRACT PROPOSAL BELOW THE DATE AND ALSO ON THE BACK OF THE
SECOND SHEET, WHICH IS THE "NOTICE TO OWNER." WE ARE SENDING TWO (2) COPIES EACH OF THE CONTRACT PROPOSAL
AND NOTICE TO OWNER. PLEASE RETURN ONE (1) COMPLETE SET TO US.
Approximate starting date:
Approximate completion date:
ALL PAYMENTS TO BE 100% ON COMPLETION UNLESS OTHERWISE SPECIFIED ABOVE
NOTICE
"Under the Mechanics' Lien Law (California Code of Civil Procedure, Seclion 1181 at sect.),
any contractor, subcontractor, laborer, supplier or other person who hatps to improve your
Property but is not paid for his work or supplies, has a right to enforce a claim against your
properly. This means that, after a court hearing, your properly 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 full, If 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, (here being no covenants, promises or agreements, written or oral, except as herein set forth.
It If 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 repre, anlalive
of any person, firm, or corporation.
PRICE SUBJECT TO CHANGE AT ANY TIME TO REFLECT INCREASED MATERIAL PRICES.
11/15/00
_ accept the above proposal.
DEW ROOFING, INC.
By: Salesman
Approved by:
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE
PERMIT NO.
344385
, COUNTY OF RIVERSIDE �� 7;,�
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. �
2ND FL.
POR.
GAR-
CAR P.
WALL
ESTIMATED CONSTRUCTION
SQ. FT. @
SQ, FT, @
SQ. FT. 9 �
SQ. FT- @ �a
SO. FT. @
SQ. FT. @
SQ. FT. @
VALUATION
$ a a
UNITS
YARD SPKLR SYSTEM
�
MOBILEHOMESVC
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$ SD —
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM FAN ❑ EVAP- COOL HOOD
`p
SIGN
WASH ER.IAUT pISHI
�.
APPLIANCE WDRYER
r.
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT L
CFM
IDLE METER
KITCHEN SINK
e
ABSORPTION SYSTEM B,T-U.
TEMP USE PERMIT SVC
WATER CLOSET
F
COMPRESSOR 3 HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED ❑ GRAVITY
d
AMPERES SERV ENT
SHOWER
dG
BOILER .0 B-T_U_
SQ- FT- (a ¢
BATH TUB
SQ- FT_ Ga ¢
WATER HEATER
Q. FT. RESID Ga 1 V,4
SEWAGE DISPOSAL
SQ. FT- GAR @, 1/.¢
3
�?
HOUSE SEWER
GAS PIPING
PERMIT FEE
3
"
PERMIT FEE
3
PERMIT FEE
FJw
DDL
OTAL EES I1eaB. HM-FEE
o7a0 �y
k!ICRO FEE
MECH. FEE
PL. CK. FEE CONST. FEE
ELECT. FEE
SMI FEE FEE
o„2
PLUMB- FEE
PERMITNO.
t435
Sapp, Permit
Job Address Space Zip
Owner
Communinity
.CW 41311 m'%�
Valua.^t(i�on/(
E
DoteJ
Is
Dist. Off.
//
F.0
I
iMH Permit Fee
E
Micro Film Fee
Cop
E
Use of Permit
�
Parcel No.
No -
Use No-
Ck.hy
Mech. Fee
Dial
E
PI Ck Fee
E
Sa IkA
Lot Siz�a
Consrruamn Fee
Dbl
b
Legal Description
/-07 r�l �a� �C�/ -)'Z
�G./ L/'Te-f�
F� G/
S 711•
S 7 /
R /_-4�
Electrical Fee
Dbl
E
Zbone
L %
Grp
Type�y
Unit
SMI Fee
$
/
Plumbing Fee
Dial
E
Bond Amr
S
Plan No
13770
Final Date InspcYiar
Sp. Insp- Fee
E
Demol Fee
E
Const Lender Branch I certify that in the perforrnance of the work which this permit is issued I shall
not employ any person in any manner so as to.bumme subject to the workmen's com-
pensation laws of California "
Address City Zip
Owner Signature
Builder Efgrreture
Regislr Fee
E
Mileage Fee
E
Witness Fee
E
Reinsp. Fee
E
Owner/Agent
Tel- Zrp
Total Fees
E
Address
'3
City Zip
Lae gG
M0.0 NC ❑ Cash ❑ Chec
Received by
Contractor
Tel.
License #
Trees required
,Sewage System
/� v, / /4"
Address
1
City Zip
Workers' Comp.
yes Q no
. `:ewer District
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF verified by:
WORK FOR I 20 DAYS SHAL�� C�E PE��AIiATOr BECQhiIE VOID.
I HEREBY AGREE THAT IQN WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
WITH THELAWSOF RIVGI . C-OUNT A11DTHE STATE OF CALIFORNIA.
So �HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
N ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF
CALIFORNIA