PLBG (1511-075) - SFD (002675)53796 Avenida Madero
9811-075
002675
LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 6Wt563 A 2/29196
License # Lic. Class '\ Exp. Date"
Date 1 " Signatureoft,ontractor.
r ,
OWNER -BUILDER DrECLA1 N
I hereby affirm that I am exempt from the Con actor'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 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 4,trTA'1'1Z F:1Tr n Policy No. 13967747740
(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'LLaaabbor
Code, I shall forthwith comply wig'those provisions. +
Date: fel, Applicant;
Warning: Failure to secure Workers' Comper s on 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 resultof this application agrees to, & shall, indemnify
& hold harmless the City of I`x i' 11th 11:' •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 fdr Inspection purposes.
1
Signature (Owner/Ag .` aUs_C
i .
ALCM
- JULDING PERMIT
PERMITS.4jit
DATE ' `'
VALUATION * LOT
TRACT
JOB SITE ADDRESS 4;3-796 AVLrNI.DA MAI)[f R0
APN 774-143-003
OWNER
CONTRACTOR
DEN:HDEK .Ni17+dF.1`RINC} CQiti
T 01) cw'""F`"'TA I Ul rrzr,l
68175 BER- os CnLram
537796 AVI Nil. A IVI DER0
CE1'F HED1tE i. CrV CEI. 92231
UN QUlWA CA 92253
(619)32.7-2200 C13L# 3577
DESIGNER/ENGINEER
USE OF PERNV4L N1_13t G-
S'aWER COMEC'I'
FEE DESCRIPTION
FEES
COW M ACT ANIOUNT 1,742.00 LS
J
ESTIMATED COST OF C ONST RUC- `10N
1,742.06
>k E'RM1` ..' KEF SUMMARY
PLUMBING FEE - SM3 4-N, 1013 0()0-419-000 34.t7t1
SUB -TOTAL CONSTRU('1'lOA7AND PLAN' CHECK,
$30,00
LESS PRE-PtA,ID.FEES
$0.00
'I afAL P Eitl4' IT 9aEl S DUE NOW
$30.00
RECEIPT
DATE
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
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 a 44g::::Pool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
/
Final
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)
HAMMER PUMPING INC.' .JOB INVOICE
P.O. Box 2448
CA.THEDPAL CITY, CALIFORNIA 92235-2448
I1a10i Qan_7AAR
%v 1 vvv i ---
(619) 321-7448
CUSTOMER'S ORDER NO.
DATE ORDERED
/ a - /? -y,3-
ysORDER
AMOUNT
ORDERTAKEN BY
DATE PROMISED ❑ A.M.
0 P.M.
BILL TO / _ ( `
r . J
Pumping Fee per 1000 gal.
PHONE
ADDRESS
MECFIANIC
CITY
HELLP/EER
)B NAME AND L'Ogflr /
'DDa
0-ffff-WORK
O
y
'CRIPTION OF WORK Q _
7-,-, (C
❑ CONTRACT
O EXTRA
i/C
Out of Area Fee .
Sp- weo
oorZ,-
UANT.
- DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Fn 00
Gafl:ons
C0 U
Pumping Fee per 1000 gal.
'DDa
Dumping Fee per 1000 gal. k
-o
O
o0
Out of Area Fee .
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH' 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT
TOTAL
MATERIALS
MECHANICS Q
HELPERS Q
TOTAL
LABOR
I hereby ackngwledge t sari actory
comp) tion of the abo d ibed work:
TOTAL LABOR
TAX
SIG77/2,AZ
DATE COMPLETED
i dL j ' S
TOTAL
S'
=
NOTICE TO OWNER
Under -the California Mechanics Lien -Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve {your property, but is not paid for his/her 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 contractor in full if the
subcontractors, laborers or suppliers remain unpaid.
To preserve their right to file a claim or lien against your property, certain claimants such
as subcontractors or material suppliers are required to provide you with a document entitled
"Preliminary Notice." Original (or prime) contractors and laborers for wages do not have to
provide this notice. A Preliminary Notice is -not a lien against your property. Its purpose is to
notify you of persons who may have a right to file a lien against your property if they,are not
paid. Generally, the maximum time allowed for filing'a claim or lien against your property is
ninefy (90) Days after completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MAY WISH TO TAKE ONE OR MORE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material suppliers through
a joint. control. Any joint control agreement should include the. addendum approved by the
Registrar of Contractors.
2) Issue joint checks for payment, made out to both your contractor and subcontractors or
material suppliers involved in the project. This will help to insure that all persons due payment
are actually paid.
3) After UPON making payment on any completed phase of the project, and before making
any further payments; require your contractor to provide you with unconditional lien releases
signed by each material supplier, subcontractor and laborer involved in that portion'of the
work for which payment was made. On projects involving improvements to a single family
residence or a duplex owned by individuals, the persons signing these releases lose the right
to file a claim against your property. In other types of construction this protection may still be
important, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-796 A ,ida M& -o LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip Tel.
TA 92253 564-4832,
Contractor
City Zip Tel.
Sam
State Lic. City
& Classif. $8704 Lic. # 626
Arch., Engr., -
Designer
Address Tel.
City Zip State
- Lic. #
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that I am, licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code,'and'my license is in full force and
effect.
SIGNATURE ff DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the 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 ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his, own employees,
provided that such improvements are not Intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec: B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
keI hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
.❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This Is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
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 ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant A f I k _ Date
Mailing Address t
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. -
A.P. Number 774-143-003
T
No. 002675
OCC. GRP.
Legal Description Lot 22
Project Description
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. f4 0.
Size 1W 1 -in- ft•Stories
No. Dw.
Units
New a Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Setback from Property Line
1" bn. feet of 3-foat high block retainlM
INSPECTOR
Issued by:
Date 11"4"x6 Permit
Validated by:
Estimated Valuation . $ 20250.00
*. PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
3b.50
Mech.
Electrical
Plumbing
S. M. 1.
.50
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
64.02
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 11"4"x6 Permit
Validated by:
Validation:
Abb43
11 4 64,b2 Ck _
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES" -
1ST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO, FT. @
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
e6/C/_REINF. STEEL —
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
rip
FRAMING y 0
SQ.FT.GAR ® 3/ac
HOUSE SEWER
/,
_
DEC
(+/ j
17 1997
GAS PIPING
PERMIT FEE
VENTILATION
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK - g
GROUND PLUMBING ^ UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADETj0
. LtFORMS
UGH PLUMB.
BONDING
HEATING (ROU H
STORAGE TANK
SEPTIC T OUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
)tEROR
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
e6/C/_REINF. STEEL —
GAS (FINAL)
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
//JJ //GROUT
C 4OND BEAM — 13 — (n
Y
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
rip
FRAMING y 0
FINAL INSP.
ROOFING
/,
_
DEC
(+/ j
17 1997
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND / %;
FINISH GRADING
(/
?FI—NAL INSPECTION--/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
40
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