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0202-233 (PLBG)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. License # Lic. Class Exp. Date Date 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: (4) 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 /2. 7 / T_ Signature of Owner 33.' 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 Policy No. (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 Labor Code, I shall forthwith comply with those provisions. Date:. Applicant 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 above-mentioned property for inspection purposes. Signature (Owner/Agent) %^�-�-- =Date " as BUILDING PERMIT PERMIT# -DATE -� V,JLUATION LOT +��,��:a TRACT JOB SITE APN ADDRESS 51-7,40 AVEMDA ]RAM : - OWNER CONTRACTOR / DESIGNER / ENGINEER KEVIN (IALLAVAN OWNER •• BUI DER g I ;240 ANWIDA RAbMEAZI LA QLTWfA CaT-0 USE OF PERMIT �1..•iS�ft�d� 80TIC.ABAZfLTIJNMENT - SE.VVER. HOP -f71✓ VAWAT1011 599199 L8 RUM;f9M COS' OF CONl lRLYMON 5.00 FEB 22 1001 CYOWITA I3E 3- COXAL >"`�'ib STRUC-11 �K .P,ND fpLMT c"'4i.E:12K - $30.00 LES -0 PRE -PAID FEU5 $0.00 I'M AL PFMM MFM :DUE NOW 1 A)0 RECEIPT DATE BY t D IN ED /� INSPE ,O�i/ 4NSPECTI0N;IREC0RD - 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 r 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 f" Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final F.�mbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test Appliances - w _ 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: Y�1W` 6 1 1 1 .Tract J. D 40u,LL -Y WATER DISTRICT `� • Q.A; Code 7 ...0 ' �QAQ.IH Fi�C�IPT D�')'AIL f ��jj77�� e , . r - st s 4. Received From ' Deter n r e' � Acopunt No• `. .,.r..,,4,_, 1 ervlce Ad so ` `Meter(s), 9ervlce(s) �] �eckflOw(e) ,,, if Mouse Lgtaral(sj ��.,,_ Lot 6 1 1 1 .Tract J. UN )d+�+• Q.A; Code 7 77— �DeteotorCheck(s) 'L "MeterSurchorge !j T ,,•'' •"`' • y -1• ` ` f 4 f Sanitation QapacityCharge r Ix1 W S 8 F.C, I Temporary Con struotlon Motor i ° 44 z Tum on Charge ' %z l�ngolfected Account Name ospectlon Fee -Tract Fe tF 'Plan Check FeewlVaterl9®wer,= fradt Bond Payment A,,D. -—Bond CustomeFDepoSlt'- I .Atller��� fit„ I z a it Remprky; �; ` Cash Check *oney 7t t 1 T, Cash • q �: y Order -1 '�tfir f4� ..., ti.. -,..... .�.:.. 5...... �1:`G,. �. _ ..... _..c- _.7i�:..- - �''�'1'-;r^:.0 i.•t«'4'xti. {" 0, 438 l t t 1891 f E:_ S It HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 17Rn1 2An _ 7AAQ (760)321-7448 DESCRIPTION OF MATERIAL USED CUSTOMER'S ORDER NO. DATE O�ERED/ Gallons 16�2— ORDER TAKEN BY DATE PROMISED ❑ A.M. • 9 -` ❑ P.M. BILL TO I PHONE ADDRESS' MECHANIC �� �'1 Out of Area Fee S CITY HELPER JOB NAME AND LOCATION �� ❑DAY WORK DESCRIPTION OF WORK �j ❑ CONTRACT ❑ EXTRA c % lel Size System: - �`r.�`Y r Vic-! /..• /Y©b�S f. QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT Gallons iFioo Pumping Fee per 1000 gal. 9 -` fc�G' 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 MATERIALS MECHANICS @ HELPERS @ TOTAL LABOR I hereby acknowledge the satisfactory completion of the above described work: TOTAL LABOR TAX SIGNATURE 91/ 1 1 DATE COMPLETED TOTAL�j%S El OWNER'/ BUILDER. .INFORMATION Dear Property. Owner: An application,for a building permit has been submitted in your..name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you are.ihe•responsible party of record on such a permit. Building permits are not required 6,be signed'by property owners unless they'are personally performing their own work. If.youi work is bein ',performed bysomeone'orherthan yourself,"you`may protect yourself -from possible liability if that person applies for'the proper, .permicin: }tis or' her name. Contractors are required by law to be licensed and bonded by the State°of.'California and to have a business license from the City or County: They are also required by law to put their license number ons all permits for which they apply. If you plan to do. y q-r,own work; with the exception of various trades that you plan to subcontract, you should be aware of the following informatiogfor-pur benefirandprotection: If you employ or otherwise'.engage,any person's other than your, immediate'family; and the work (including materials and other costs) is $200.00 or, for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. ; If you are an employer, you must register with the State and Federal Governmer t'as.an employer and you are subject to several obligations -including :State and,, Federal income tax withholding, federal'social security taxes, worker's compensation insurance, disability insuiance costs and:unemployment compensation contributions. There may be financial risks;for you if you do'riot carry out these obligations, and_these risks are especially serious with respect to,worker's compensationinsurance. For more specific information about your obligations under, Federal Law, eontact.the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstiatron):'For more specific information about youriobligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not.licensed contractors are allowed to.perform their work"personally or thiough. their own`employees_w' ithout a licensed contractor or subcontractor, only under limited conditions. " A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property, owner"is .providing• his ,or her owfi"Jabot ' and material personally. Building permits':are not required "to be signed bye property owners unless they are performing 'their own work personally. Information about licensed contractors may be, obtained by.coniacaing the Contractors' State License Board in your community of at 1020-N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -.builder verification. form' so thai-me can confirm.-, that you are aware of these matters. The building permitwill not be issued until the verification"is returned. ' Very truly yours, CITY OF LA QUINTA DEPT: OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta,CA 92253 1 (760) 777-7012 FAX (760) 777-7011 OWNER'S SIGNATURE/DATE PROPERTY ADDRESS PERMIT NUMBER(s) c V