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9802-121 (PLBG)LICENSED CONTRACTOR DECLARATION I. hP,reby affirm under penalty of perjury that I am licensed under provisions of CP pter 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 URI 14 01? vDate ��`"� 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. 7044, 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. (\A) 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. S'i'rs: t'I•;1' 13A:D Af6."OW5d58 (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,o� Section 3700 of the Labor .041 Code, I shall forthwith comply with those provisions., /Date: 112 i q01 l" Applicant %✓ Warning: Failure to secure Workers' Compean 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. /Slgnature (Owner/Agent) ` y�f Date .1, f f� PERMIT# ;y CONTROL# BUILDING PERMIT �14i)w x.21 DATE 212419K VALUATION LOT TRACT 6887 JOB SITE ADDRESS :f113.-9AVVN4 4A�'ViXLL CJ0 APN r 73-+1.71-OZ6 OWNER CONTRACTOR/DESIGNER/ENGINEER erTLKLN SPIR !'GEIR A d C1 SERVICE, tI C I'o EtXJIX li+I 16919.LI�";CL13 It1liU�d aC) E@l ), LA Q1.J1NTA Cad 427.5:1. DESEKI'1•i1ASYRIN+,fir: CA 14h240 it�19?+2 -1 7`1 C IiLft ;1841 USE OF PERMIT .504TI.+„` Ar3fi: VrV t3!�:R'ilb 1,8410,00 LS . J94 LiiIX.T9'..9J CkOS 4'sF'CONTSIv:,`(ICT ON i.s�01).l1'!i Pts t. FMB I:t4(IVEH •SEWED IDI.000419.-000 S3ttt* A' FE 2' 4 ,19 g ! t( -IT A1,, (;"{')NSTeft IC17ON AN1) P!, AN t'f9F'CK, 4141 i. SS PRE -PAID FEES $0 00 'i'OTAE P RM6T MEN1133 NOW �3ti.sii4 s RECEIPT DATE BY I '1J F AL 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 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans _ Sewer Lateral _ O.K. for Finish Plaster Pool Cover _ Sewer Connection �� Encapsulation Gas Piping Gas Test Ap41i noes _ _ 2 _ /� Y Final COMMENTS: 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 t t Final Utility Notice (Perm) A•1 CESSPOOL SERVICE, INC. JOB INVOICE _',�' *�tA L P.O.' oz 183' Desert Hot Springs, CA 92240 " 'Since 1959 (619) 329-6875 . DAT _ CUSTOMERS'S ORDERNOE ORDERED State Lic. #265214 CIL QUANT. DESCRIPTION OF WORK PRICE AMOUNT • ORDER TAKEN BY DAT PROMISED J� BILL TO ce.5 50P0- � r� 1 c. PHONE ' ADDRESS �j fj�j , .-ya, IC MECH��A,�/ ["'t I G CITYJ % - HELPER L ' ' 01 A Ga: . Dumping Fee per 1000 gal. JOB NAMEAND LOCATION ( - - - "Sa O DAY WORK Out of Area Fee O T,A��' DESCRIPTIOCIT .NOF LYOR: - ' CIL QUANT. DESCRIPTION OF WORK PRICE AMOUNT Gallons J� 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. A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS._ , QUANT LABOR AMOUNT TOTAL MATERIALS MECHANICS @ - TOTAL LABOR HELPERS hereby eckovAedge the satisfactory co I.. ebweaesc Werk: TOTAL LABOR.1 TAX - SIGNATUR€ ? DATE COMPLETED _ TOTAL. _ NOTICE TO OWNER Under the California Mechanics Lieii Law any contractor, subcontractor, laborer, supplier, or other person wh'i helps to improve your property, but is not paid for his/her work or 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 ur material suppliers are required to provide you with a document entitled "Preliminary 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 r lien against your property if they are not paid. Generally, the maximum tone allowed for filing a claim or lien against your property is ninety (90) Days after the completion of your project. TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY, YOU MAY WISH TO TAKE ONE OR MOREOF 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 insure that all persons due payment are actually made. 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 suppliers, 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 be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE SIGNED. ..■ CESSPOOL,`_ u.�•.-'.'-.',�w:�.....?yFq[T:..er-�w�•.�.�,r7•alt^�-ya*.,-.raR^.�yY-:.-,�.-^...•�-•--.r�v�...�.`..--..- A 4. SERVICE, .INC. JOB INVOICE P.O. Box i83 Desert Hot Springs, CA 92240 'SI 1959' r1Ce CUSTOMERS'S ORDER NO. ' DATE ORDERED ' (619)329-6875. Gallons' State Lic. #265214' ° _ ORDER TAKEN BY DATE PROMISED BILL TO MI PHONE ADDRE - MECHANIC I `;. �.. .� _ f' kal ' CITU f .) _ '.. ". HELPER JOB NAMEA D LOCATION+ O DAY _WORK -+ DESCRIPTION OF WORK1 O gbtf TRAC t/EXEAl- / 1 ^ l U QUANT - DESCRIPTION OF WORK . - PRICE • AMOUNT Gallons' 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. A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. QUANT • LABOR _ - AMOU WOTAL. MATERIALS MECHANICS w a' HELPERS ® TOTAL`'" 'cLABOR. .x f hereby ackoWedge the satisfactory scTOTAL LABOR' completion of the above dedbed work: SIGNATURE DATE COMPLETED . ;•fir A .. TOTAL' = 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 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". 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 the completion of your project. TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY, YOU MAY WISH TO TAKE ONE OR MO.REOF 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 insure that all persons due payment are actually made. 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 suppliers, 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 be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE SIGNED.