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9903-009 (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: (�,) 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). ( .) .1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code),:! (1 yam exempt u der Section B&P:C. for,this reason . r,Date 1X t", �J Signature of Owner/' �! ?'%i -I t f " WORKER'S COMPENSATION DECLARATIO 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). (x) 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 fotthwith comply with }`hoser provisions. ' t rVi. Date: r! Applicant I t )1,411P11Lr' l r. IIIYJ,./. I i 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. Ipp®QRTONT Application is hprQhy made to thP.. DirP.Gtor 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 inspectio purposes. /Signature (Owner/Agent) � f h �rrr.' 9),I -At � � � Date � r Y PERMIT t/ BUILDING PERMIT i I t^- DATE 3� 9 VALUATION ES'2;g00#) LOT T4CT ADDRESS 54-981 A��,l�d,wSYD!'�.,L�t�f��ER17,w JOB APN r ,. OWNER CONTRACTOR / DESIGNER / ENGINEER MAX S[F'F.k.It Mm,4E.-tIBIA6,;:.DER 104101 %t'C;P.KER CT ELK tRO�VE CA 95624 j CriL4 USE OF PERMIT I'i.,11`MBNO:r SEPTIC ASAN(Ni�nrNT AND ZETWIR. CC NNt ECT 1 VALUATION 250.001.5 ESTIMIX.I'ED. COS.T OF WNSTRUCTION PIERM f i' FEE SUMMARY +:9.tJM33 [ U FW — SEWER 10J -000-Q941100 $30100 ti) tJ4.- � � �� `r1 E•it .G+r t V D °na 3/10 SUB- (OThAY, CON'STR.fJ("110N A!, M_ PLAN PK * CH MOO la (�1 i.•V,f At, .iiE�R A A. A• FE S, 011KNOW 530.00 FIECEI T� `�DATE By 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 Ap,pliances L /S Final Fina /T Utility ELECTRICAL APPROVALS Temp. Panner Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels `!,A- erior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: .+ tlbl —Z, f, �.kt �.,.. �r•+kT•" ,.q;.ti �. .r r.-* .,.y-....:� .v.p.li �.:s.'-.,.rg :G...�H. .x• Y;, COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 7 17 �. S Received From: r (� Date: Address: Account No, • •' �� %� % �� . n • Lot(s) Tract Service Address ��- � � Z,Lf"lt�F�C,�C�,e±2G.A. Code -'r ❑ Meter(s) $ ❑ Service(s) -. .. ❑ Backflow(s) ». s,,�y'•- _ — ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account -Name ❑ Inspection Fee -Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - — ❑ Bond Payment - A.D. —Bond Assmt. ❑ Customer Deposlt ❑ Other TOTAL Remarks: I I { ❑eQPy to: /ter Cash Water Service CheckL.J�`l3 ;y Money v:' Cashier. Order r CVWD-438 (11189) a HAMMER PUMPING INC. P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 (760) 360-7448 JOB INVOICE, (760)321-7448 DESCRIPTION OF MATERIAL USED CUSTOMER'S ORDER N_O. DATE O DERED S ORDER TAKEN BY DATE PROMISED .�A. M. ® P.M. BILL TO PHONE ADDRESS Pumping Fee per 1000 gal. M HANICC •� .•CCff��•.•�ii�' CITY HELPER % �J E A C TION �(( SPY - SAT _ i H ( �7 (/\� L �. \ JT_DAY 1'LDAY WORK _ DESCRIPTION OF WORK _ Dumping Fee.per 1000 gal. ❑CONTRACT ❑ EXTRA F-Oao QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT (Oo p" Gallons Pumping Fee per 1000 gal. v� Dumping Fee.per 1000 gal. S� Out of -Area Fee Locating Opening Fee (per hour) T( ` "Y ,,,Sizer -System: " t� If 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 Q HELPERS @ TOTAL LABOR I hereby cky" ledge the satisfactory TOTAL LABOR completio'k of t e above described work: TAX '- SIGNATURE � � DATE COMPLETED TOTAL � 11 '� � ;# y HAMMER PUMPING INC. P P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448, (760)360-7448 JOB INVOICE; (760)321-7448 QUANT. DESCRIPTION OF MATERIAL USED CUSTOMER'S ORDER NO. D5 ORDERED. ,C?O(D Gallons 00 C) ORDER TAKEN BY DATE PROMISED 0 A.M. 0 P.M. BILL TO PHONE ADDRESS M�LIAMC CITY HELPER y JOB NAME ANDPC kTI?N Out of Area. Fee D-DAY WORK t DESCRIPTION OF,W� Locating Opening Fee (per hour) 0 EXTRA Size System: V QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT ,C?O(D Gallons 00 C) Pumping Fee.per 1000 gal. 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 @ TOTAL LABOR HELPERS @ I hereby acknowledge the satisfactory completion of the above described work: TOTAL LABOR TAX 'SIGNATURE DATE COMPLETED TOTAL 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 -fol 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 -court officer and the proceeds of the sale used to satisfy the indebtedness. This can happen even 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 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 material suppliers involved in the project. This wilt 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 involved- 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 your property. In other types of construction this protection Mr ay still be important, but may not be as complete: TO PROTECT YOURSELF UNDER THIS OPTION YOU MUST BE CERTAIN THAT ALL.MATERIAC: SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE SIGNED. _ • r 3/22/99 CITY OF LA QUINTA 1 INSPECTION SUMMARY REPORT Permit Number 9903-009 Site Address 54-881 AVENIDA RAMIREZ Rereference Number Site City Location of Project Date Applied for . 3/1/99 Date Approved Owner Name MAX SIEFKER Date Issued 3/l/99 10401 SIEFKER CT Date Finale& 3/16/99 ELK GROVE CA 95624 Date Expired Contractor Name OWNER/BUILDER Valuation $250 Fees 30.00 Description of Permit SEPTIC ABANDONMENT AND SEWER CONNECT • INSPECTIONS S CHEDULED O R C O M P L E T E D Scheduled Completed Date Date Time Inspection Type Inspctr Inspection Result Inspectors Comments •3/15/99 3/15/99 C5 -SEWER DPC PASS 3/15/99 3/15/99. C4 -ABANDON DPC SEE NOTES SEPTIC TANK ONLY, PIT NOT FOUND UNTIL SI E VISIT..ABANDONMENT FOR " PIT REQUIRED FOR FINAL. PUMP TICKET RECIEVED FOR SEPTIC TANK. OWNER CAME TO COUNTER AT 2PM REQUESTING . INSPECTION. 3/16/99 3/16/99 C4 -ABANDON DPC SEE NOTES PUMP TICKET RECIEVED FOR SEEPAGE _PIT. PIT ABANDONED. OWNER CAME TO COUNTEE AFTER 3PM TO REQUEST INSPECTION. 3/16/99 3/16/99 D2 -COMP** DPC PASS 4 Inspections completed. r