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9607-125 (PLBG)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C\1w Professionals Code, and my License is in full force and effect. 7) M License # Lic. Class R Exp. Date O T i96698C12 Cad C42 t '+/31/97 r` ZO arte " Signature of Contracto-A co 0rn J U OWNER -BUILDER DECLARATION � W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's co License Law for the following reason: Z_ ( ) 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). c'') () I am exempt under Section , B&P.C. for this reason u) N Date Signature of Owner ON D) d Q WORKER'S COMPENSATION DECLARATION p 2 cr I hereby affirm under penalty of perjury one of the following declarations: LO Q () 1 have and will maintain a certificate of consent to self -insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor, Code, for the O � Q performance of the work for which this permit is issued. m Q C) ( ) I have and will maintain workers' compensation insurance, as required by Q USection 3700 of the Labor Code, for the performance of the work,for,which this Il 0)H permit isrlssu d. My workers' compensation insurance camerit& policy no. are: ,It Z Carrier Policy No. �a J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wit. thos provisions. )Warning: Failure Applicant► /) all. o-. 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 prope for Inspection purposes. Signature (Owner/Agent�� Date79� A��1' 4 G BUILDING PERMIT PERMIT# 96"1CONTROL# �"z� 3800DATE 7/30/461 VALUATION• sI.,,C1ltl.00 LOT TRACT JOB SITE S"6 AVENIDA 1'.L+`LASCO APN 774LSZ-05 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER KEVIN T & MAky DIA Lill) DATEL.,'4ND CONMIM~1' ON 4346 AVENIDA V LASCO 50.10514WY i 11 LA QUINTA CA 92253 COACkt1311.1.A ('A 92Z 46 IC►1�11�4-�R?(S (fi10']1h;•tFi;�� (.'.}3I.# i) USE OF PERMIT PI.IfhiltlNt.i AIIANIX)N'iSs'['1'It�' Cf}I�1Nf's�"! tiI?W% 1XI't11AT,ED CUST U[, Ct. INN'TR[11:"i'IGN 1,w.00 3'k.KIL�f 1' �'� �: �t1MNfAiKY -00(! Sifl.� FgJJN1Rf?40I^fiXLs - 9VWV',R 101 -MO -40-001) S!:[E3=1UI'Al, CONS! 1ti1C'.'C1.ON AND PLAN CHECK 530.00 [, ISS PRU-11A1D FEUS /� ��. PERMITf<'EwS �)a NOW �o o 6 RECEIPT \ 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 OX 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 Appliances Final Final /v Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fodures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: r' r Received F m: KAY I. h iCL60 COACHELLA VALLEY WATER DISTRICT recu =1101r nrrwu N2 Address: c OT t � Lo U I n r6 - 0A -- - '! Account No. D 13 I b� v v Lot(s) 5 f N zq �` Tract e' Service Address 4 3 4 b PM 1 �( cLy e•. a c,. G.A. Code F ❑ Meter(s) $ ❑ Service(s) .n ❑ Backflow(s) i ❑ House Laterals) j ❑ DetectorCheck(s) l❑ Meter Surcharge 01 Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ 'Temporary Construction Meter ;t ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee -Tract- : Fee - i ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit Y ❑ Other TOTAL Remarks: W \ \ VY-\ 0- -❑Copy i $ 0 copy to: ' CashWater Check I 4 Service Money Order Cashier 0 HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 I&In%'DcA 7AAC -.-I vvv -i —w PRICE CUSTOMER'S ORDER NO. D E ORDERED (619) 321-7448 GZP.Limping Fee per 1000 gal. ORDER TAKEN BY DATE PROMISED ❑ A.M. 0 P.M. BILL TO AM Co N'i'l" QNE ADDRESS M C IC CITY Y HELPER {v J JOB NAMIE AND LOCATION Locating / Opening Fee (per hour) WAY WORK DESCRIPTION OF WORK ��- ❑ CONTRACT !i ❑EXTRA J t A QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT il-Gallons GZP.Limping Fee per 1000 gal. a umping Fee per 1000 gal. Out of Area Fee Locating / Opening Fee (per hour) Size System: !i Ll V ' A SER CE CHARGE OF $20 WILL BE DUE N ALL RETURNED CHECKS. A FINANCE C ARGE OF 11/z% 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 completion of the above described work: TOTAL LABOR TAX SIGNATURE TDATE 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 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 in full if the subcontractors, laborers 6r 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 throvali a joint control. Any joint control agreement should include the addendum approved by file 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 4R, a residence or a duplex owned by individuals, the persons signing these releases lose the•rigtrt— 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. NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 4 Plenums 8 Ducts 2A Slab Grade 35 Fuinoce Comport. 3 Steel 36 Inlets 8 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor - Roof Deck 39 Appl. Clearance 7 Framing - *g 1 O 40 Fire Damper '• tt 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 • Fireplace P.L. E] Final 10A fireplace T. 0. °o ------ ADDITIONAL INFORPTION n yrs{_ ; It ✓` _ z • � -------- ------ _ - - - -_------ - - - - -.- . - - - -.- SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall •—Finish Gicde .�.._. INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 1 1 12C Ceiling (Blown) El 4 Final ------------------- PLUMBING'APPROVALS--------------- 15 Ground Plumb 16 Water Piping 17 Rough Plumb g, 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test P5 Final 9 ll K .Z Tank Pit L. Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/L P/ 26 Power Pole 27 Conduit - 28 Service Entrance 1_29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service %32 Final STREET NAME Count yr of Riverside Department of Building and Safety 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Stref d 227 North "D" Street 46209 Oasis St. Rm. 310 160 N. Broadway Riverside, CA 92501 Banning, CA 92220 Hemet. CA 92343. Perris, CA 92370 Indio, CA 92201 Blythe. CA 92225 Ph: 787-6146 Ph: 849-7312 Ph: 6564464 Ph: 657.3898 Ph: 342-8271 Ph: 922.2670 This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Date CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred (f100) or less. 1 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 Calllorma. Lic. Number Date Applicant Contractor NOTICE TO APFUCANT: IL after making this Certificate of Exemption, you should become subject to the Workers' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. It. however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.). PI, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, siness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ 1 am exempt under Sec. B. 8 P.C. (Attach Certificate) Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 381X1. Lab. C.). Policy No. Company Certified copy is hereby furnished. Certified copy is filed with'the County Building Inspection Department or County Date Applicant Department. APPLICANT NAME (L, F. MI) - ADD / t->•- C!j/CO MUNIT /S A`((:/ZIPJZ�• %l{ •�,�Ir �. v r J ^SlFE ADDRtSS/SPA E ./ / U sky y C `^ l/ / MU„ • Y' .ATE/ZI� ! 1 4V \/ i /f -A C..r B Y� PAG PITO/ �, yr: („ T1 1 >NG �^.••�+'' SE S CY .C�••` r r ., • OT MOD SB TRACT NAME .rf __ ''''� OWNER NAME (L"F •� '— / cv CONTRACTOR -FIRM NAME i cijyWC MMUN Y/S.TA'TE/ZIP .5 ! -t, PHOf1E LICN Nr AZE`NG-PIRM NAME `.-"r. - - - ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N . LICNC N USE OF PERMIT BL ZON FSB SSB SSB RSB OFC ZONE ORD N LOT SZ END SIDE Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or d smantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 341, Title 8. C.A.C.) RaAs owner-tuilder, I will not eroploy anyone to do work which would require a permit from the Division of Industrial ety, as noted above. unless such person has a permit to do such work from that division. ❑ Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I iave read this application and state that the above information is correct. I agree to comply with all city and County ordinances and slate laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to building con- struction, and authorize a representatiJe of the County of Riverside, Department of Building and Safety to enter upon the property for which) have applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applican-/Agent Name APPUPRMT N PS DATE :. 1001018 r r r5 TOTAL i FEE�- __ INSPECTOR�IMPY, 001018 FORM 284208 (2/81)