14396 (PLBG)44
P.O. BOX 1504 No. 14390
Building 78-495 CALLE TAMPICO
Address 51--262 Ave. Ramirez LA QUINTA, CALIFORNIA 92253 "
Owner Ms. Este Hallock
Mailing
Address Same .
City Zip Tel.
La Quinta, CAI. 92253
Contractor
Denboer Engineering & Construction
AV&essj%5 �Berro&" Court
1 citeP CWS, 92234I1ei-619) 327-2200
State Lic. I City
& Classif. A B . 684563 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
`. LICENSED`CONTRACTOfS DECLARATION'
I hereby affirm that I amjicensed under provisions of Chapter9 (commencing with Section
71700) of Division 3 of th'28usiness and Prpfessloos Code, and my-11cense is
full torte and
effedi" c' ' �- / J, .i �Fira'" r,... 0 . _ pi,
Al OWNER -BUILDER DECLARATION
1 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, after, improve, demolish, or repair any structure; prior to, its .issuance. also
requires the applicant for such 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 five 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.. lf, however,. the building
or improvement is sold within one year of completion, the owner -budder will have the burden.
of proving that he did not build or knprove for the purpose. of safe.)
O I. as owner of the property, am exclusively contracting with licensed contractors to con- •
struct the project. (Sec. 9044, 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 contractors) [rcensed 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 1 have a certificate of consent to self -insure, or a certificate of
Worker'sG°mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poliic�cy, rN'00 Company
b�c:opy 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.thF 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 FINES7UP 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 1 have read this application and state that the above information is correct.
I agree to comply with all city -and county_ ordinances and slate 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
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description '
Sewer Connect
Project Description'
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$11320.00
i
PERMIT
AMOUNT
Plan Chk. Dep..
Plan Chk. Bal.
Const.
Mech.
Electrical
„
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
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
Validat,
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIUFEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®'
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN -
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. /� �S/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c I
IBATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE •
JCONST.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
s
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER R SC
a
ROUGH 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.
i
FINAL INSP.
FRAMING
FINAL INSP. /� �S/
ROOFING
l �D
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
19ZIOI '29Zn-7AAQ
(619) 321-7448
CUSTOMER'S ORDER NO.
DATIY�DE76
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
Gallons
PHONE
DRESS
lie
NIC f' I
61TY
HELPER
A
1779Q, 14LI
/<
C
\t5 -DAY -WORK
ESC , OF WORK
/PJI'TION
4�. o t/..
q"CONTRACT
O.EXTRA
#00
tQUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
�60
Gallons
Pum'ping Fee.per 1000 gal.
G
Dumping Fee per 1000 gal.
Out of Area Fee
Locating Opening Fee (per hour)
de,
Size System:
A StRVIWCHA�R�E OF $iO WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF ill/2%"PER MONTHj 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOU T
TOTAL
MATERIALS
MECHANICS @
HELPERS
TOTAL
LABOR
I lereb' acknowledge the satisfacto"
c.m,l e1jj, of the above descr i bed work:
TOTAL LABOR
TAX
SIGNATURE/
I
� ..- DATE COMPLETED
_
C�
171
NOTICE TO OWNER
Under the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve your property, but is not paid for his/her work or,
supplies, has a right to enforce a claim against your property. This means that after a tou'll
hearing, your property could be sold by a court officer and the proceeds of the sale Used to I
satisfy the indebtedness. This can happen even if you have paid your contractor in full if the$
subcontractors, laborers or suppliers rernain unpaid.
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 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 throug�
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 youi contractor and subcontractors or
material suppliers involved in the project- This will help to insure that all persons due payment
are actually paid.
3) After UPON making payment oq any completed phase of the project, and before making
any further. payments, require your contractor to provide you with unconditional lien releases
igned qy�.each material supplier, subcofitractor and laborer involved in that portion of the
work for which -payment was made. On projedts involving improvernerils to a single 6mily
residenc6 oe'! duplex owned by individuals, the persons signing thes�eftleases lose thdAght
to file a claim against your property. In. other types of cmrshuction this protection may -still be
important, but may not be as complete. TO PROTECT YOUASELF UNPER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.