9804-139 (PLBG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chia t 'r 9 (commencing with Section 7000) of Division 3 of the Business and
P4ofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
2667.14 i042
Date f'/ f 1/7' 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
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:
Cartier Policy No.
:� I hi.l i' ftl'3u�4`'>{I13�«E��i
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
/bate: %/% r ✓� "Applicant
r
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,"a'bove-mentioned property for'inspection' purposes.
.Signature (Owner/Agent) ' Date-',
BUILDINGPERMIT PERMIT# CONTROL#
7671 DATE 4/ZZ/98 VALUATION $t 4� ' i LOT TRACT
ADDRESS 46-965 HIGHLAND ��E3�s!�' S 1�R8T1IV JOB SITE
APN 1343-191-02
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DAN 'f-IUMES'"011
A -I Cr'SS110 1, Sr --VICE, INC
45000 c:;I10P. OR
1dt319 .L,i"nto AIt.`,iR-oNiaCa ii).
INDJAN WELLS CEI, 92210
ix.,s oai-It`;t'SrRlNo: C11. tf..,_mo
USE OF PERMIT
id
8 PTtC AiiANi)ON, S.i-:%V.E,ttC(YNN4 C s: t
PAID
APR 2 2 .1998
VjkLuAr o.Ni i I., to . u L3
CITY 0 F LA QUINTA
J�.Rl If P.• i9�Ci C\e�.l��V iiia 1. X
Pri,RN1.R i FE.V S6.i.11"AMetRY
1.1Tri!iBINOFEE,4• tit;?,'d►ER 101-000-094)00 $30.00
s t
Qg""i��. Vi+:¢9t1' 1�I+�4 1)1lir;`tCl1r;31�,t9ti
RECEIPT
DATE
BY f
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
Appliances / _
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
t
Final
Utility Notice (Perm)
Final
COMMENTS:
-
",y-a,--mom.-�at'�^ +-
' COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
-. Received From: r
1T 1�(� (�,(i
_`°`:t c e•�.. - - _
'
_ .,t'-�!'a
nate
C n �
!XA1 I•[./tFLLJ
Address:
Account No. Lots)
Tract
PA
Service Address Ne IG.A.
Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
. ❑ Detector Check(s)
❑ Meter Surcharge
-5S
/ O
Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account -Name
❑ Inspection Fee - Tract -
Fee -
❑ Pian Check Fees Water I Sewer -
Tract -
• ❑ Bond Payment - A.D. - Bond
Assmt
❑ Customer Deposit
❑ OVier
TOTAL $
Remarks: / / G6 t � h AI
J Copy to:
__ -. . Water Service
A-1 CESSPOOL SERVICE, INC.
P.O. Box 183
Desert Hot Springs, CA 9224"�
'Since 1959'
(619) 329-6875 CLISTOMERS'S OF
State Lic. #265214 ORDER TAKEN BY
------------
.TO A 1 7/- ;,3e- q
JOB INVOICE
ORDERED
PROMISED
_7c/_6Y
vi C 0
ADDRESS I MECHANIC
C. Wes A a
CITY 'HELPER
JO A. AND "OCATIO
All" 2 ra G C
0 DAY WORK
F 0
DESCRIPTION OF WORK L ', 111 In_ CONTRACT n
OUANT
DESCRIPTION OF WORK
PRICE
AMOUNT
Gallons, I
PunI Fee per 1000 gal.
Dump!ng as per 1003 gat.
Out�i Area Fee
Locating Opening Fee (per hour)
1.
Size System:
A SERVICE CHARGE OF $20VOLL BE DUE
. ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE
CHARGED ON PAST PUE ACCOUNTS OVER 30 DAYS.
OUANT.
AMOUNT
TOTAL
MATERIALS
MECHANICS @
TOTAL
LABOR
HELPERS @
I hereby ackowledge the satisfactory
completion of j1te. be described work: • ME LABOR
TAX
snNATURE7
I DATE COMPLETED
9
TOTAL
i_
r
NOTICE T WNER
Under the California Mechanics Lien Law any ontractor, subcontractor,
laborer, supplier, or other person who ?ielps to it proveyouur property, but
is not paid for his/her work or hearing, your pro} erty;codld-be sold by.aa
court officer and the proceeds of the sale used to sat 'sfy the indebtedness.
This can happen even if you have riaid your cons ractor in full if the
subcontractors, laborers, or suppliers„remain unpaid.
i
To preserve their right to file a claim or lien against your ,property, certain
claimants such as subcontractors of material suppliers • re required to
provide you with a document entitled("Preliminary Notice"-lA Preliminary
Notice is not a lien against your property. Its purpose is to *notify you of
persons who may have a right to file alien against your property if they are
not paid. Generally, the maximum time allowed for filing a /claim or lien
against your property is ninety (90) Dads after the completion o'j your project.
-.:,'....,moi= �-.`-"t+ti.•C'..�7S:..r:=..y`1: �..+n.,-+`.-Y'.:,.,-^�_....�..r+. ..• -�_. - ---
TO INSURE EXTRA PROTECTION FON YOURSELF ,AND YOL;;4ROPERTY--,-
YOU MAY WISH TO TAKE ONE OR hOREOF THE FOLLOWI&G STEPS:
1) Require that payments be made Jectly to subcontractors ai:1 material
suppliers through a joint control. Any joint control agreement should include
the addendum approved by the Regi4trar 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 insure
that all persons due,payment are actually made.
3) After UPON making payment on y completed phase of the project,
and before making any further pais, require your contractor to pi•ov;de
you with unconditional lien release ''signed by each material suppliers,
subcontractor and laborer involved n.that portion of the work for which
payment was made. On projects invo vng improvements to a single family
residence or a duplex owned by 'in i t iduals, the persons signing these
releases lose the right to file a claim, gainst your property. In Wier types
of construction this protection ma' Mill be important, but may be as
complete. TO PROTECT YOURSELFjUNDER THIS OPTION YOU MUST BE
CERTAIN THAT ALL MATERIAL SUPOLIERS, SUBCONTRACTORS OR
LABORERS HAVE SIGNED.i
ice✓