9511-077 (PLBG)P
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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. 684563 A 2129/. '
License # Lia Classe'� Exp. D e--\
Date L1 ignatureof Contractor
OWNER -BUILDER DECLAR"N
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. 70 „Business & Professionals Code).
( ) -1 am exempt under Section�,�f?E�,.(4for this reason
Date Signature of Owner 4'�+i £ti,
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 TrAnz f umn Policy No. 1196"n
(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' compensationlprovisions of Section3700 of the Labor
Code, I shall forthwith comply with those provi¢ions.
Warning: Failure to secure Workers' I�pensation 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 application agrees to, & shall, indemnify
& hold harmless the City officers, agents and employees.
F2. 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.
5,511-077
DATE ab "• I VALUATION LOT
IJOB SITE ADDRESS :3-.175 AVEt+NIRA (BERMUDAS I APN 774-065-020 I
ArfLLT.AM & IR TATRti��i,tMER
SAME
LA QUINTA CA 92253
SFVWR CONNECT
URN80ER I NGINECitING & CONST.
68175 BLRROS COURT
CATH:EDR.AL CITY . CA 92234
(619)32.7-2200 CHI.# 3577
DESIGNER/ENGINEER
FEE DESCRIPTION I FEES
CtCaN'URACT AMOM 1.895.00 L8
TIMI fEla COST OF CONSTRUCTION I,S9�.1415
PERMIT V14,9 SUMMARY
PLUMING ME -- S.FWER, 101 -000 -1139 -tom) 530.00
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 representative�of th' City to enter upon the
above-mentioned proper rinspection ur Best
Signature (Cwner/Ag Date `I RECEIPT
SUB -TOTAL CONSTRUCTION AND PLAN CMCK:I $30.00
LESS PR..E-PAID FUSS $0.00
DATE
TUFAL PERMIT >, E S DJUC NOW 1 $130.00
INSPECTOR
INSPECTION RECORD
i �`
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 7 ce
Encapsulation
Gas Piping
Gas Test
Ap li nces
Final
Final G
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
,/1C�11995 10:49 5193273211 DENBOER ENGINEERING PAGE 02
DENBOER ENGINEERING AND CONSTRUCTION
687175 BERR03 COURT, CATHEDRAL CITY, CA 92234.
GENERAL, ENGINEERING CONTRACTOR
PHONE (61.9) 327-2200 FAX (619) 327-3211 LICENSE #684563
January 10, 1996
109COR1A.WP$
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Attn: Tom Hartung
RE: Sewer Hookups/City of La Quints
53-175 Eeriauda.s
Ar
Dear Sir:
We have been unsuccessful in locating a sewer lateral at the above mentioned
location. The following Procedures have been tried with no luck.
(1) Underground Service Alert was notified and C.V.W.D. marked sewer
lateral.
(2) Digging at marked location and 15 feet to the south and 3 feet to the north
(north limit is concrete driveway approach). The digging was done to a depth of 8
feet (sewer main in the street is at 8 feet deep) and to'the back of the curb.
(3) Reverified with C.V.W.D. engineer at their office the lateral location as
marked in the field. Location verified.
(4) Met with La Quinta City engineer to verify lateral location as shown on their
As built plan. Location verified.
We are requesting.a change order in the amount -of' $250.00 to cover costs to video
this line to -determine the lateral location.
If you have any questions or eommenta please contact use.
Sincerely:
4DenF-nqineeri and struc=ion
er, General Manager
' HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
IIR701 2RA_WA4
#---' - `—
(619) 321-7448
CUSTOMER'S ORDER NO.
DATE ORDERED
— 1— 5 i
ORDER TAKEN BY
DATE PROMISED D A.M.
Gallons
❑ P.M.
BILL TO _
Pumping Fee per 1000 gal. r
PHONE
S
on
ADDRESS
ME ANIC
ate.
CITY
6)00
HELPER '
JOB NAM€ gfJD �Of�ATIQN
S_ `7
5,0
GO
rAY WORK
/7
❑ CONTRACT
DESCRIPTION OF WORKw.
Out of Area Fee
e C
❑ EXTRA
Se w< 0^
7 D o•
Locating / Opening Fee (per hour)
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
1600
Gallons
1000
Pumping Fee per 1000 gal. r
S
on
6)00
Dumping fee per 1000 gal.
5,0
GO
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
f C r>�
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 Q
HELPERS Q
TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
completion of the above described work:
TAX
SIGNATURE
DATE COMPLETED
TOTAL
135
d,
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 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 to 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 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 latiorer 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 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.