0209-155 (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
%Xlauf,
Date Signature of Contractor
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
co6tractors 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 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 STATE POND Policy No. 11946Ec`1.-411
(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 provisio _0
-Date: f- ! Applicant 1 A AA 7701
1 1 �'?- �`
Warning: Failure to secure Workers' Compel�sation 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 j
& 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 for inspection purposes.,)
'Signature (Owner/Agent)
0 ILDING PERMIT PERMIT#
DATE 91 L9M2 VALUATION ` ^ LOT TRACT
JOB SITE ADDRESS �'7-7.V� V3rf ,�'�•�J'S 50
f Y l+.Pi4 � 1.Y. NITS S.'
APN _ LL
OWNER
CONTRACTOR/DESIGNER/EN INEER
BCDMOOiE
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14.75iAOENUF 50
6�if4..i3£�1!�4i
1AQX)TATA CA 92253
CK(BAKDRALC'.WT C41%. 9222.4
USE OF PERMIT
GMAY.:JUI MICY
R1• 410OF WITH UA, 4.;i.A"r-.MR T11-9 ROCI r Y: T9M
L IB TC}!'ITTOM AND t5i `k 1?i;,`
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FINANCEDEP?
s
RECEIPT
DAT ,
„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
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
`h tw
w ..
Final
Final
— cg— 7
1POOLS-SPAS'
`
' BLOCKWALL APPROVALS.
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
3
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 PiDina
COMMENTS:
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
Temp. Use of Power
Final
Utility Notice (Perm)
Co rate Office:
2626 Newport Blvd.
Costa Mesa, CA 92627
949-548-1645/Fax 949-548-2617
R0"'O itle
License #460707
Desert Office:
68314 Kieley Road .
Cathedral City, CA 92234
760' 324-5482/Fax 760-328-4612
PETRONELLA ROOFING hereinafter called."Contractor" and!or "Seller', agrees to provide the following listed labor, materials and construction:
NAME: La Quinta Country Club
CITY:. La Quinta, CA 92233
DESCRIPTION OF LABOR, MATERIALS AND MISC.:
ADDRESS:'77750 Avbnue 00
PHONE: (760) 664-4151
Petronella Roofing.agrees to.provide labor, equipment and materials to-install..a
U.S. Clay.lite. Tile Roof System in strict accordance with the written specifications
as submitted by Micha&i Petronella for La Quinta Country Club.
Main Rdof Contract Price..............................................$51,9.20.00
U.S. Claylite Tile Roof System
Lifetime Tile Warranty
Fifteen (15) Year.Contractor's "Weahtershield" Warranty
Unit Prices on Extras
A. 2 x 8 Rough sawn fascia/prime & paint dtnc*ided at $9.50 per lineal foot.(,fif:r.))
B. 1 x 6 shiplap/prime & painted included at $7.50 per lineal foot.
C. 1/2". plywood at $2.50 per square foot.
D. Electrical atrroof - provide and install new hard E.M.T. conduit at electrical
penetration and route through high barrel portion of tile.. (Woi:k'to be performed
at a time and.ma(t�erials basis.)
Option N17 -7. 1 A
A. Hip Roof (Additional)...........................................$3,9735.00
SPECIAL INSTRUCTIONS: Terms: 1/3 Upon Award of Contract
1/3 Progress Payment
1/3 Final Payment Upon completion of worki
(, . -A.,4.t-t_t:At.. t
TIME FOR STARTING AND COMPLETING PROJECT: Work shall 'commence within ten (10) days from the date of sale unless specified
otherwise and be substantially completed in approximately ten (10) working days. with additional time
to be allowed as detailed in Paragraph 9. of the Terms, Conditions. and "Notice to Owner" on the back hereof. Substantial Commencement of work
shall be. defined as the installation of any materials and/or 116bor. Contractors failure to substantially commence work,' without lawful excuse,"Within
twenty (20) daysfrom the date specified: above is a violation of the Contractors License Law.
NOTICE TO BUYER: (1) Do not sign this agreement before.ydu reaa]t. (2) You are entitled to a completely filled in copy of this agreement. (8) Owner
acknowledges that he has read and received a legible copy of this agreement sighed by Contractor, including all Terms; Conditions and "Notice to'
Owner" on the reverse side, before any, work was done, and tKat'he has read and received A. legible copy of every documerit that Owner has signed
during the'negotiations. (4) YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME'PRIOR TO MIDNIGHT OF THE THIRD BUSINESS
DAY. AFTER THE DATE OF THIS TRANSACTION BY NOTIFYING THE SELLER, IN WRITING;, AT THE ADDRESS ABOVE. IN THE EVENT YOU THE
BUYER FAILS TO EXERCISE THIS RIGHT AND SUBSEQUENTLY ATTEMPTS TO.'CANCEL THIS, CONTRACT AFTER THE EFFECTIVE DATE OF
RECISION, THE CONTRACTOR SHALL BE ENTITLED TO RECOVER ALL COSTS AND LOST PROWITH FITS ASSOCIATED THIS CONTRACT.
.(5) YOU, AS OWNER OR TENANT, HAVE THE RIGHT.TO REQUIRE THE CONTRACTONJO HAVE A PERFORMANCE AND PAYMENT BOND
OR FUNDING CONTROL.
NE BUYER)
O NER-BUYER SIGNAT E
OWNER -BUYER SIGNATURE
DATE FSALE
CONTRACTOR(SELLER)
SALESPERSON _
SALESPERSON SIGNATURE "
July 23, 2002 �a t
DATE OF SALE
PRICE
$ 3755—
CONTRACT PRICE
$ 17,306.67
DOWN PAYMENT
See terms above.
BALANCE DUE
UPON COMPLETION