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15879 (PLBG)P.O. BOX 1504 Building 78-495 CALLE TAMPICO Addr&�M--105 Avenid-a Radia^ LA QUINTA, CALIFORNIA 92253 Mark and Sandy Sa f f ry Mailing Address same as above City Zip Tel. La Quinti 1 92253 564-1192 Contractor Address ity jZip J Tel-: State Lic. I City & Classif. Lic. # Arch.; Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 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,.. ahfer...tm'piove, demolish, or repair any structure, prior to its issuance also requires the applicant 'fo%soh-permit to rile 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 rive hundred dollars ($500). O 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.) ❑ 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 pro/acts with a contractor(s) pcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B: & P.C. for this reason Date Owner .WORKERS' COMPENSATION DECLARATION I hereby affirm that. l 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. ❑ 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: d, 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE'IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP, TO ONE HUNDRED THOUSAND DOLLARS. ($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. This is a building permit when properly filled out, signed and validated, and is subject to expiration if 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 LDING: TYPE CONST Number No. 15879 OCC: GRP. Legal Description Project Description sewer connection Sq. Ft. No.. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 5 o oo PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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: Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIWU FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER S ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1Ya c SEWAGE DISPOSAL INSULATION/SOUND SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 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 SEWER S ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. QU/ v ✓ q>d FINA P. FRAMING FINAL INSP. 9 91� ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL - INSPECTOR'S SIONATURESJINITIALS GARDEN WALL FINAL d# . . r. Y � . .. �_-':.�: � ..T T - � r!^,'_ .:.^-,'W2?V^[v.C�'Jo•.""iwMl r ,. f.. .. � Received F Address: Account N .Service Ad, ❑ Meter(s). ❑ Service(s) ❑ Backflow(s) ❑ House`Lateral(s) ❑ DetectorCheck(s) ❑ Meter;Surcharge s [5anitatfon Capacity Charge .i ❑ W.S.B.F.C. ❑ .Temporarq Construction Meter ❑ . Turn'on Charge. ❑ Uncollected Account -Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water l'SevJer.- Tract - ❑ Bond..Payment-- A.D. -.Bond Assmt. b. Customer Deposit ❑ :Oilier COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Remarks: ,HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 &THEDRAL CITY, CALIFORNIA 92235-2448 C-1ni "I&f% 7A A 0 (619) 321-7448 CUSTOMER'S ORDER NO. DATE�tDEJF� h I ORDER TAKEN BY DATE PROMISED 0 A.M.. 0 P.M. BILL TO PHONE ADDRESS 7- '1111C Ej CITY HELPER 08 NAME AND LOCATION 9-BAY'WORK 0 CONTRACT qCRIPTION 0 ORK S-020- 0 EXTRA ffa 0 ,,UANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 'Z5'—L') Gallons '600 Pumping Fee per 1000 gal. 000 Dumping Fee per 1000 gal. S-020- -0-0 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 AMOU T TOTAL MATERIALS MECHANIC� @ TOTAL LABOR HELPERS I hereby acknowledge the satisfactory TOTAL LABOR ,comprktion of the above-described, work: I TAX YAT�R _jTE COMPLETED a. %. 7 —TOTAL 00 NOTICE TO OWNER Under the California Mechanics Lien Law any contractor, subcontractor, taborer, 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 thal after a court hearing, your property could be sold by a court officer and the proceeds of the sale used to s�dtisfy the indebtedness. This can happen even it you have paid your contracior in full if *the subcontractors, la66rers or suppliers remain -unpaid. To preserve their right to file a claim or lien against your property, certain claimants such ps subcontractors or material suppliers are required to provide you with a document entitled "Preliminary Notice.J" Original (or prime) contractors and laborers for wages do not have to provide this notice. A'Preliminar Notice is not a lien against your property. Its purpose is to' ly 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 ninety (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 maferial suppliers involved in the project. This will help to i6iure 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 falilily 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 constr6ctidn', 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.