INST (0700)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
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This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS 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.
License Class
Lic. Number
Date Contractor
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) orthat 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.):
0 1, as owner of the property, or my employeesswith wages as their sole compensation, will do the work, and,the
structure is not intended or offered for sale (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 does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
bu ilding o r i mprovemnt 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.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct 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.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner '
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified•copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished.
I Certified copy is filed with the City Building Inspectio DepartmenCor City � Department::
Date r� s Applicant%t'L�
APPLICANT ILUF. MMI)P���'^ 60
ADDRESSLL�j I
CITY/COMMUNITY/STATE/ZIP
JOB DRESS/SPACE5lI(E/ r3��`✓Z Vn✓
CITY/COMMUNITYISTTAATE/ZIP
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%BOK�j PAG PRC%� C
=M)1340 61
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TRACT
LOT
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TRACT NAME
r
OWNER NAME (L. F. MI)
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CONT, I (0 1 e- NAME jA
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ADDRESS ,.,.
CITY/COMMUNITY/STATE/ZIP '
PHONE
3#/ - 3(10 019
LICNC
AARC/ENGRRCEENG FIRM NAME
ADDRESS t
CITY/COMMUNITY/STATE/ZIP _
PHONE •
LICNC •
USE OF PERMIT ,
BL
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ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
-
TOTAL .
FEE
END
SIDE
ty a
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIOWINSURANCE: This section need not be completed it
the permit is for one hundred ($100) o, 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 Applicant
NOTICE TO APPLICANT: ;IL alter 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. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8:
C.A.C.)
• 0 As owner -builder; I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
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, Civ. C.).
Lender's Name
Lender's AddrE
I certify that I have read this application and state that the above information is correct.) agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT
DATE
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TOTAL .
FEE
+ DO
VALUATION
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
o
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
1 Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37.
Combustion'Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
OWN
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath'`'
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents .. ._.
19 Sewage. Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
s
HAMMER PUMPING INC. JOB INVOICE
' P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
IC'1 01 OCrl_7A AD
1ViJ� JVV'/-r-rV
(619) 321-7448
CUSTOMER'S ORDER NO.
D19- ORDERED
7
ORDER TAKEN BY
DATE PROMISED O A.M.
❑ P.M.
BILL TO ,w -
PHONE
ADDRESS
'000
C
CITY
—
HELPER
JOBry(Q�ME AND LOCATION
J e l/`A0 z
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La VC tlC
0' WORK
❑ CONTRACT
DESC n TION OF WORK
DDD
0 EXTRA
S ^
/T00 t-71
r
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
'OOD
Gallons
'000
Pumping Fee per 1000 gal,
O S
—
00
DDD
Dumping Fee per 1000 gal.
S ^
s-0
r
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
rr(, ` h
re_ r
/
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
HELPERS Q
TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
com tetion of the above described work:
TAX
SIGNAT _
G7j �
DATE COMPLETED
L/ oZ0
TOTAL
I
1 Y v (' i
NOTICE TO OWNER t
Under -the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve your property, but is not pald.for•hls/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
�satisfyAhe indebtedness.'?his can hal'Ven-even if you ;have pai#,.yoy.g_W
Iractor in.fuU if the
subcontractors, laborers or suppliers remain unpaid.
s
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 cla' nn or lien against your pr6perty is
ninety (90) Days after completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MAYVISH 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 addendufn approved by the
Registrar of Contractors,
2) . Isspe joint checks for payment, made out to,.both your contractor.and*suboo►ilreetors or
mateolved in the pr'ojecl.'This Vill help to insure that all persons due payment
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.