9802-078 (PLBG)LICENSED CONTRACTOR DECLARATION
I hereby under of that I am licensed under of
PERMIT# CONTROL#
BUILDING PERMIT 4)X"2.078
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affirm penalty perjury provisions
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Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
License in full force
DATE VALUATION $1,612.00 LOT' TRACT
6842
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Professionals Code, and my is and effect.
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License # Lic. Class Exp. Date tt
684561 A. 6 HAZ A�;6 €yl�Ol}
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'ADDRESS
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Signature of Contract
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CONTRACTOR/DESIGNER ENGINEER
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OWNER -BUILDER DECLARA_TIN
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I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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68-17S URROS MUM'
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License Law for the following reason:
LA. QUI91'A CA 97,253
C1i i'I-IEDR.AL CITY CA 92734
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( ) 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
USE OF PERMIT
sale (Sec. 7044, Business & Professionals Code).
as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
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SEPTIC AaffiWN-DO , SEWER CONNECT
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Code).
() I am,exempt under Section , B&P.C. for this reason
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ON
Date Signature of Owner
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WORKER'S COMPENSATION DECLARATION
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I hereby affirm under penalty of perjury one of. the following declarations:
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O 1 have and will maintain a certificate of consent to self insure for workers'
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compensation, as provided for by Section 3700 of the Labor Code, for the
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performance of the work for which this permit is issued.
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I have and will maintain workers' compensation insurance, as required by
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Section 3700 of the Labor Code, for the performance of the work for which this
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permit is issued. workers' compensation carrier policy no. are:
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Carrier Policy No.
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(This section need not be completed if the permit valuation is for $100.00 or less).
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O I certify that in the performance of the work for which this permit is issued,
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I shall not employ any person in any manner so as to become subject to the
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workers' compensation laws of California, and agree that.if,l should become
subject to the workers' compensation•provisions of Section 3700 of,the�Labor
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Code, I shall forthwith comply withohose provisions
fDate:�4 --• _ h,,J Applicant 1,4
Warning: Failure to secure Workers' Com nsation cove age is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, daViages 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
i
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 - .
441t-4fitAl.E."S)7+i'1217�'IC1I�:`13� i�1.A�f CF1I~C
& hold harmless the City of La Quinta, its officers, agents and employees.
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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
fEGD't.t:,L PFR11��,1. FEES -011C NOW
�i3f6.414b
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that'l have read this application and state that the above information is
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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 properxy*for inspection purposes. n
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
nature (Owner/Age 't)� /� • z^ Date ' i• '
.7
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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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
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COMMENTS:
Final
Utility Notice (Gas) 1
71
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
a
Smoke Detectors
Temp. Use of Power
Pinal
Utility Notice (Perm)
N
WMEMENT
HAMMER PUMPING, INC.
DATE
P.O. Box 2448
4-22-98
CATHEDRAL CITY, CA 92235-2448
NUMBER
(760) 360-7448 or 321-7448
9287
California Contractor's License
661018
Tri-Star
52-703 Ave Velasco
La Quinta, Ca. 92253
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TERMS:
PLEASE DJTACHf_ND RETURN WITtI
YOUR REMITTANCE T $
-
YCHARGES AND CREDITS? t.a
5 BALANCE` sy '
BALANCE FORWARD
4-21-98 P =
1000 Gallons - Pumping
Fee-
85.00
4-21-98
1000 Gallons- Dumping
Fee*
t
5
00
r ,r.
Total Due
135
00
j
HAMMER' PUMPING, INC.
PIN HSTAMOUNT ,
IN THIS COLUMN
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
17CA1 2GA _ 7A A Q
QUANT.
(760)321-7448
CUSTOMER'S ORDER NO.
DATE �JRDE ED
7u
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TO
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PHONE
ADDRESS
ME (AI
CITY
HELPER
JOB NA
OCA N_
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Dumping Fee per 1000 gal.
❑DAY WORK
DESCRIPTION OF WORK
_1100
❑ CONTRACT
0 EXTRA
S
`
Out of Area Fee
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Ino
Gallons
CR
ad
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
_1100
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 ®
HELPERS Cad
TOTAL
LABOR
I hereby acknowledge the satisfactory
completion of the above described work:
TOTAL LABOR
TAX
SIGNATURE
DATE COMPLETED
TOTAL
3
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 histher 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 -t6
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 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
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.