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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
/J . 396698 C12 Cad C42 v"4Yi�
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).
( ) I, as owner of the property, am exclusively. contracting with licensed
contractors to construct the project (Sec. 17044, 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:
Cartier 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. J
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
BUILDING PERMIT PERMIT#4�u��t,
DATE 9134198 VALUATION t'; � �(` LOT
JOB SITE
ADDRESS 77-7.80 CA XEP c`HILLON APN
OWNER
CONTROL#
TRACT 8350
CONTRACTOR/DESIGNER/ENGINEER
7 I Lk.00J.'US H. t iiAVAR i)t�f.e. A r " vT "�i OX- i /�"..'LP 11 Q C0N. ",9l uU f ON
777SO CALLS CHILLON- • 50305 F.{�vy I I
L.ti QY.>INHA CA 97453 COACHELLA CA 422.36
� 60)398-5544 t;k3L#� . M
USE OF PERMIT
PLAM INN
COMAC',i A UNT I,12NI i.00.(,,S
PER.NHT E', SitKfi AR'S'
PLUfv}£iING'sV Z a1-WER �11.01�0 .4I4t_1'1i r $;x{1.00
9u-
SEp 3 0 '199 .
LESS FRE-TIAID FE FS
TOTAL 9CRMIT FEES DOENOW
RECEIPT I DATE I BY I " I DATE FINALED I INSPECTOR
]9GVt tXOJ
$1.0.00
$0.00
$30,00
INSPECTION RECORD
..ti
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 I
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
Appliances
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
r
Final
Utility Notice (Perm)
COMMENTS:
Remarks:
Copy to:
I
�� 16
Date: 9_
Tract
G.A. Code
'r
TOTAL S
WaterServlce O
-Cashier
CVWD-438(11189)
Tye,
Recelired From:
Address:
��
' / ,
Account .
4 ' /91,0
Service Address
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ 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 -!
,x
❑ Plan Check Fees Water I Sewer -
#
Tract -
❑ Bond Payment - A.D. - Bond
A
Assmt.
❑ Customer Deposit
❑ Other
Remarks:
Copy to:
I
�� 16
Date: 9_
Tract
G.A. Code
'r
TOTAL S
WaterServlce O
-Cashier
CVWD-438(11189)
I
W,
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
(760) 360-7448
(760)321-7448
CUSTOMER'S ORDER NO.
DATE ORDERED
/ 0 - ,Z --t b
ORDER TAKEN BY
DATE PROMISED _ ❑ A.M.
l�
b P.M.
PHONE
ADDRESS
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ME NIC
CITY
HELPER
JOB NAME AND LOCATION
d a'
S—d
f'1DAY WORK
DESCRIPTION OF WORK
Out of Area Fee
❑CONTRACT
—,
�
�
❑EXTRA
rr
Locating / Opening Fe (perthdur)
QUANT.
DESCRIPTION OF MATERIAL USED '
PRICE
AMOUNT
I�
Gallons
l�
Pumping Fee per 1000 gal.
!� O
Dumping Fee per 1000 gal. (�
d a'
S—d
r!-41
Out of Area Fee
Locating / Opening Fe (perthdur)
D C
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 Q
TOTAL
LABOR
HELPERS @
1 hereby acknowledge the satisfactory 0l LABOR
completiort of the above de ed work:
TAX
SI NATURE!
Yl� V,I-010/4
DATE COMPLETED
�
TOTAL
3�
NOTICE TO OWNER
Ur -der the Cautornta Mecha;,,_ ...en a r%i,y cojllldLtUl,' o,xa,LU,a...._ ^^.r
or other pz.son who helps to improve your -property, but :i not paid for his/her work or
supplies, has a right to enforce a claim against your prope.ly. This means that after a court
hearing, your property could be sold by a couri officer -and the proceeds of the sale used to
satisfy the indebtedness. This can happen even if.you hale paid your contractor in full if the
subcontractors, laborers or suppt:rrs rero— oi.^.paiu.
Td preserve their right to file a claim or 1' your prod.=- ty, o—tain claimants such
contractors or material suppliers ^rr. r L xrf,. :-ov,ue you with Aocument entitled
<ary Notice." Original (or prime) laborxrs for wad. +o not have to
^ �naticc. A P,eliminary Note _ ;s not a ,ii jai: it your property, 4vrpose is to
persons who may have a right to file a uen ~..,jst your property h .. 'iy are not
pe:,., 1-,e maximum time-llcw,d for ng a c, iv against your p; perty is
ninety r ` completion of- = ur proje'
TO ENSURE EXTRA PROTECTION FOR YOURSELF AND YOUR P001'ERTY,
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.
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.
s`) `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 may still be
:--portant, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MtiST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED,