14405 (PLBG)w r .
;Yez.,
414 • P.O. BOX 1504, ' No. 14405
Buildingy 78-495 CALLE TAMPICO.
Address 46.775 Wa shingto.n LA QUINTA, CALIFORNIA 92253
Owner Ms. Phylliseter Pollard
Mailing BUILDING: TYPE CONST> OCC.,GRP.
Address Same
A.P. Number
.City Zip Tel. •
Ls -Q"wt--ai 9s. �.3. Legal Description
4
Contractor " Sewer -.Connect
Denbcer ' dng_.neer.ing a Construction
Project Description
Ad
W-175nii�rras tour --
City'c'.athedra'd C1 Vp CA 9223 Tel sig)—2
State Lic. City
& Classif.. ,it'; B 684563 Lic. #
Sq. Ft.
Size •
Arch.; Engr.,
Designer New O
Address Tel.
City Zip State
Lic: #
LICENSED
CONTRACTORSTECLARATION..
I hereby affirm that I am jcensed under provisions of, Chapter 9 (commencing with Section
4 7,000) 00f Division 3 of th?.siness and(Professi ns Code, and my licens tsirrfull force and
c effect! / ! W, . d wbi ei f r
No. ' - No: Dw.
Stories Units
Add O. Allier O• Repair ❑
' OWNE -B IL`DER DECLARATION ' Estimated Valuation
I hereby affi that I am exempt from the Contractor's License Law for the following - ,
reason: (Sec. 703.1. 5, Business -and Professions Code:. Any city.or�county which requires a•
Permit to construct, after, 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 .PERMIT '
the provisions of the Contractor's License Law, Chapter 9'(commencing with Section •7000) of .
Demolition ❑
AMOUNT.
Division 3 of the Business and Prolessfons Code, or that. heJs exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for. a permit
. •Plan.'Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). , ' - • . - ' - '
- . .
Plan Chk. Bal.
❑ 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, Buisness and
Const.
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,.
Mech.,
'
provided that. such improvements are not intended or offered for sale. If, however, the building
.
or improvement is sold within one year of completion, the owner -builder will have the burden
•: EleCtflCal
of proving that he did not build or improve for the purpose of sale.) _
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con--
Plumbing
struct the project. (Sec. 7044, Business and Professions Code:'.The Contractor's License Laiv.
does not apply to an, owner of propertywhobuilds or improves thereon, and'who contracts for
• S.M.I.'
. • -
such projects with a contractor(s) )icensed•pursuant to the Contractor's License Law.)
-
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby, affirm that I have a certificate of consent to self -insure; or a certificate -of'
Worker's_ Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
- -
PolicY,No Company
d0bopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
30 . ou
CERTIFICATE OF EXEMPTION FROM
REMARKS •
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100)- valuation
or /ass.)
-
I certify that in the pertormance'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
Dite Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you_shouldjbecome
' ZONE: '-
BY:
subject to the workers' Compensatlon provisfons of.theLabor Code, you must -forthwith. •
comply with such provisions or this permit shall be deemed revoked.
'MIf11R1Un1 Setback Distances: '
_
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND • " .
''
Side Street Setback from Center. Line '
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES'AND CIVIL FINES.UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF. COMPENSATION,:
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION3706 OF THE'.LABOR CODE, INTEREST, AND
ATTORNEY'S FEES..
'
FINAL DATE
-
INSPECTOR•-
This is a building p`errtiit when properly. filled out, signed -and validated;.and is subject'to -
expiration it work thereunder is suspended for 180 days.
I certify that 1 have read this,.applioation and state that the above information is correct.
Issued by:
'Date Permit w
I agree to comply with all city and county ordinances and state laws relating to building
construction, hereby
and authorize representatives •of this city to enter. the . above -i.
mentioned property for inspection purposes:
Validated by:
!
Signature of applicant ate
Date-
Mailing
Mailing Address -
'�
Validation:
i i, �+r • -
City, State, Zip
,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIPO FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
- ^ •
FLOOR DRAIN
MECHANICAL FEES
-
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED-
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
"
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL • HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
"BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING -
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
_
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE&INITIALS
GARDEN WALL FINAL
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
L.
2ND FL..
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. N $
UNITS
SLAB GRADE
SO. FT.
YARD SPKLR SYSTEM
SO. FT. (u MOBILEHOME SVC
BAR SINK
SO. FT. it 1POWER OUTLET-
ROOF DRAINS
SO. FT v
DRAINAGE PIPING
SO. FT /ft
DRINKING FOUNTAIN
SO. FT. (n.
URINAL
VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
HEATING (FINAL)
FLOOR DRAIN
MECHANICAL FEES
GAS (FINAL)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. C. c
BATH TUB
'
SO. FT. Gp c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RES ID @p 1 !A c
SEWAGE DISPOSAL
SO.FT.GAR @ ?,c
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
SPARK ARRESTOR
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
T
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE R SE/�
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xb
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP. ��5
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
f.OAMMER PUMPING INC. JOB INVOICE
• P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
IC7^I OCf% 7AA0
IV J1.71 JVV -f TT%a
(619) 321-7448
CUSTOMER'S ORDER NO.
DATE ORDERE
ORDER TAKEN BY
DATE PROMISED O A.M.
0 P.M.
BILL TO
PHONE
ADDRESS
MEC
k.
CITY
HELPER
JOB NA fjND L," D G ,C ��
l/L_ /
DAY WORK
0 CONTRACT
DES (TJION OF WORK
❑ EXTRA
r.;
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE .
AMOUNT
f 0100
Gallons
Pumping Fee per 1000 gal. K
p
,��
]S-
o
a--
(QD�
Dumping Fee per 1000 gal. I
,SDS
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
F `
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
TOTAL
LABOR
HELPERS,p Q
I herebyacknowledge the satisfactory
completion ofrihe above described ork:
TOTAL LABOR
TAX
'
SIGNATOR _
a�
DATE COMPLETED
02� G(�
TOTAL
�-
_ 14'.
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 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:n6t
aid: General) the maximum time allowed for filing a claim or lien against ourpropeF '
P Y, 9 9 Y ti:. �, .. ;.
ninety (i90) Days after completion of your project.
ry �.:
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 addendufn 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 belbre niakfnty*
any further payments, require your contractor to provide you with unconditional tien:releases
signed by each material supplier, subcontractor and laborer involved in that poMop'of the ..
work for which payment was made. On projects involving improvements to a.. ing%�fahthy
residence or a .duplex owned by individuals, the persons signing these releases.lose the :fgh.,t
to file a claim against your property. In other types of construction this protection may sbit be
important, but may not be as complete. TO PROTECT.YOURSELF UNDER, THIS-ORTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS.QR LABORERS,
HAVE SIGNED. ,^
r`.