9511-068 (PLBG)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 684-%3-'J"291
License # U CI��ee
Date �! SignatureofContr;X ! ��
OWNER -BUILDER DECLABA ION
I hereby affirm 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:
Carrier STATE FUM Policy No. 1396640
(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 -l -should become
subject to the workers' compensation prd5is""ions of Sedon 3700 of the I or
Code, I shal forthwith comply with thd'� provisions.
Date: (Applicant
Warning: Failure to secure Workers' Compen ' n 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, intarest 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�g application agrees to, & shall, indemnify
& hold harmless the City of Indian'- ells -'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 C' to enter upon the
above-mentioned property"-.
inspectio � purposes, r�
Signature (Owner/Age, t4' Date I l�
ALC9
BUILDING PERMIT -
PERMIT1511-069
DATE y 1 ?
VALUATION •14A -.0c
LOT
TRACT -
JOB SITE ADDRESS 51-825 AVENIDA RAM.1jI EZ
APN 77X165-016
OWNER
CONTRACTOR
DENK)ER ENGINEERING 3c. C.ONSI'.
LUPE VASs; UT7,
68115 SERROS CCUIRU
51825 AVENIDA R AMIREZ
CATHEDRAL CITY CA' 922..34
INDIO CA. 92201
(611)327-7200 CBI,# 3577
DESIGNER/ENGINEER
USE OF PERMIt%Ur%1k$1N4i
SE WFA COWNT3 T
FEE DESCRIPTION
FEES
COWRAC't' AMOUNT 1,742.0!0 LS
ESTIMATED COST OF CONXrRU(_-f1ON
1,742.400
PF:11MFf FEE SUMMARY
P:LUAfiBTNCs FEE --SEWER ER 101-000-419-0.00 $30.00
SUB -TOTAL CONSTR=10N AND PLAN CLI.ECK
$30.00
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT F)r &S DUE NOW
S30.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR j
r"
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 Y
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
0/V
Final
Final G
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:
_ p-
:,,HAMMERVUMPING M. -
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448.
JOB IPS Vt
1vi.7/.0%0v-1 7 -TV -
(619) 321-7448
DESCRIPTI NOF MATERIAL USED
CUSTOMER'S ORDER NO.
DATE ORDERED
'
Gallons -
ORDER TAKEN BY
DATE PROMISED D A.M.
'J 0 ()
Pumping Fee per 1000 gala
D P.M.
BILL TO / r
PHONE
I r` f LJ
ADDRESS
MENIC (
_S� �°
J °'D
V (/tiC t✓
CITY
'All
e.
HELPER
.)B N"AT'M�EJj�NDD LOCATION
v C` . �C�s'I.G\J. �C �"•�c lX aA t�
❑ DAY WORK
iCRIPTION OF W K
j
_-/ !� t
••�S•'�./e�-C
CONTRACT
D EXTRA
$ e ms c e f`
tet- � r r
j -la
,QUANT.
DESCRIPTI NOF MATERIAL USED
PRICE
AMOUNT
jD0
Gallons -
'J 0 ()
Pumping Fee per 1000 gala
Dumping Fee per 1000 gal. ) X
_S� �°
J °'D
00
'All
e.
.
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 AMOUNT
TOTAL
MATERIALS
..
MECHANICS @
TOTAL
LABOR
HELPERS @
I hereby acknowledge the satisfactory
completion of the above described work:
TOTAL LABOR
_TAX
SIGNATURE -
DATE COMPLETED
TOTAL
I � .�
057
i
C)Ti�:E TC3 D ��EF'2
}
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 court
hearing, your property could be sold by a court6officer and the proceeds of the sale used to'
satisfy the indebtedness. This•can happen Oven if you have paid your contractor in full if the
subcontractors, laborers or suppliers remain 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 YOUkELF 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
material suppliers involved in the project. This will help to insure 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'invoived 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 yotlr property. In other types of construction this protection may stili be
important, but may rrot be.as complete, TO PROTECT YOURSE� UNDER'THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.
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