BLDG (0011-042) + PLBG (12259)52330 Avenida Martinez
0011-042
12259
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.
tense # Lie. Class Exp. Date,_
Signature of Contractor
i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(w). 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).
( ) 1, 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. is reason
Date. '"' ' Signature of Owned^
WORKER'S COMPENSATIO1` ARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain atcertificate 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:
Carver Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(Jel 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' compensate n provisions of Section 3700 of the Labor
Code,0shall fo with comply wit p provisions.
Date:Applicant • ,
1V.. Warning: Failure to secure Wo ompensation 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 oginspection purposes. _
Y
$ignature (Owner/Age V Date , J
- BUILDING PERMIT ?ERMIT#
DATE VALUATION LOT'} TRACT
JOB SITE
APN
ADDRESS
52-32%) NVENIDA1,41AIMM7,
OWNER
CONTRACTOR / DESIGNER / EN (NEER
,;?,-3 @ s#Af 1DAMt'}.it1 , Y.1 CA
LA (JUNTA CA. 92758
USE OF PERMIT
CM— T R Fii tl t 5i"v
230 LF. &' f iJiC l;';'Af.l • C.R'iY bi. 3;)A j:1 k
' A
V FT. SYAL,L 2W.00 L
Fxnw rw,;"o ruff, consmucriory
•y y,7 , •a+g•.ry p, g,y
G°O33M'RUCTION FIRE 101-00-418-000 a81.00
t
e
t
SUB-TMAT. fiOME'RUM- 0.4 AND VeLNT CIECK
$81.00
L;#s'M PRE -FAD 1.
$0.00
f
` NA_., IEEE I-IMEN DUE NOW
NA ITIA
RECEIPT
DATEj t
BY
DATE FINALD
INSPECTOR
-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs r
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:
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backsf,�Q 5�
Footings 4 1 d '.
Electric Bond
Main Drain
Bond Beam
Approval to over
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
.+ •
p k.
P.O. BOX 1504 N o .
Building 334 t1 Dem 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
fir. FIredrick Aguado BUILDING: TYPE CONST. OCC: GRP
Mailing
Address Same
City Zip - Tel.
La Quinta, :-CA X2253
Contractor'
Hendricks®n_ Construction, Inc.
Address
608-315 Rleley Road.
cittathedral Citrlp 92234 Tel. 328-1747
State Lic. City
& Classif. A 25.5184 Lic. # 194
Arch., Engr.,
Designer
Address I 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 usines andjP rofes§ions Cod and my licesn a is in full force and
effect. rri .P,
SIGNATURE - - 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, I 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 of completion, the owner -builder will have the burden
of proving. that he did not build or improve for the purpose of sale.) _
O 1, 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker'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 t
_ Ihereby 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 Date
Mailing Address
City, State, Zip
32259'
A.P. Number
,Legal Description
Project Description
Serer Connect
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
SideiSetback from Property Line i
FINAL DATE
r ` INSPECTOR
Issued by:
Date
.® 't
LJ
Estimated Valuation
$1 , 638 V OO
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.-
ech.Electrical
Electrical
Plumbing
13010 11)
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
JU ..0
REMARKS
ZONE:BY:
'
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line '
SideiSetback from Property Line i
FINAL DATE
r ` INSPECTOR
Issued by:
Date
.® 't
LJ
Validated by:
t
Validation:
t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
MESH
INSULATION/SOUND
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEV�ER,QQ,&EfWAG-ZAAWq-290,13ROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
e
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -2Y 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
"'
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
turn pan _ SAAR
i7'6 -0-i-32-1-7,44-8
DESCRIPTION OF MATERIAL USED PRICE
CUSTOMER'S ORDER NO.
DAT ORDERED
_ 23 (0 -
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TO
Pumping Fee per 1000 gal.�--
PHONE
ADDRESS 5^� / v /34uV
CITY j •�
_—AND
HELPER
JOB NAME LOCATION
Dumping Fee per 1000 gal.
❑DAY WORK
DESCRIPTION OF WORK
0 CONTRACT
0 EXTRA
Locating / Opening Fee (per hour)
QUANT.
DESCRIPTION OF MATERIAL USED PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.�--
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE .
ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON
PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT TOTAL
t
MECHANICS @ MATERIALS
TOTAL
HELPERS @ LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
completion of TAX
SIGCOMPLETED
TOTAL
Z