15224 (PLBG)• P.O. BOX 1504 N o . 15,224
Building 78-495 CALLE TAMPICO
Address 52 811 Ave. villa. -_LA OUINTA, CALIFORNIA. 92253
Owner Seca Tainta Palms Realty .
Mailing " " -
BUILDING: TYPE CONST. OCC: GRP.
Address . P.O. . Box 3406
A.P. Number
City Zip Tel.
La Quintan. CA .922.56 Legal Description
Contractor 1 C1 3TProject Description
il2ibil1ACa
Address
P.O. Box 1555
ci
La Quanta, ZIp92253 Tel.: -CA 564--1338
State Lic. City
& Classif.. 53.7333 Lic. # 2526 Sq. Ft. No.: No. Dw.
Size •Stories • Units
-. -
Arch.,•Engr., - -
Designer _ New ❑ Add ❑ Alter ❑. Repair ❑ Demolition
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that am licensed under -provisions of Chapter 9 (commencing with Section
000) of ivi 3 0 .tti3 Business a d Professions Code, and my license is in full force and
effect f��
SIGNATURES DATE
OWNER -BUILDER DECLARATION Estimated Valuation v �1
I hereby affirm that I am exempt from the Contractor's. License Law for the following $1, 00V a 00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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 .. - ' - AMOUNT
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, ano 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 -civil penalty of not more than five hundred dollars ($500).
O I,.as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and Const.
Code: The Contractor's License Law does not apply to an owner or property who
builds or Improves thereon and who does such work himself or through his own employees, -
n provided that such improvements are not Intended or offered for sale. If; however, the building Mech.
or improvement is sold within one year of completion, the owner -builder will have Lhe burden Electrical
of proving that he did not build or Improve for the purpose of sale.) '
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- •Plumbing- 3 w cis
struct the project. (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 contracts for S.M.I.
such projects with'a contractors) pcensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby'affirrn 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 Noi Company.
y is filed with the city. O Certified copy is hereby furnished.
TOTAL 30.0.0
CERTIFICATE OF EXEMPTION FROM REMARKS
• WORKERS' COMPENSATION INSURANCE
- (This section need not be completed N the permit is for one hundred dollars ($100) valuation
'or less.) ' -
I certify that in the performance of the work for which this permit is issued, I shall not
employ any peon -in any manner so as to become subject to the Workers' Compensation
Laws of Californirsa
Date Owner
NOTICE TO- APPLICANT. N, after making , this Certificate of Exemption you should become ZONE: -BY:
'subject to the Workers' Compensation provisions of the, Labor Code, you must forthwith Minimum Setback Distances:.
comply with such provisions or this permit shall be deemed revoked. - - -
Front Setback.from Center Line
Rear Setback from R;ar. Pi°o.p.LLine
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 SECTION .3706 OF THE' LABOR CODE, INTEREST. AND f / ' ^w
ATTORNEY'S FEES. `/�/ /7
This is a building permit when properly filled out, signed and validated, and is subject to' FINAL_DATE NSPECT, V —
expiration if work thereunder is suspended for 180 days.. R
I certify that I have read this application and state V that the above information is correct. Issued by: - Date Permito_
I agree to comply with all city and county ordinances and state laws relating to building - ���
construction, and hereby authorize representatives -of this city to enter the .above.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip \ y
•K.
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. @ $
UNITS
HEATING (ROUGH)
2ND FL. SO. FT. @
FORMS
YARD SPKLR SYSTEM'
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT. @
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE - DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
H
SEWAGE DISPOSAL
SO.FT.GAR @ 3/<c
IHOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
I 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
SEW OR�
ROUGH WIRING
DUCTWORK
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.mv
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
��7
Received From :lr`.
,
r Date:L s
\
Address: l— / - C „ - Y, ; a' 1", 3%Li{ r �,17'�
n n Cr %i/• n �'�n
Account No. �— .',? f i?/' h.. O' C Lgt(s) `'
•� Tract
Service Address n.�!� Z 6L1_ � /.9 ri-
G.A. Code
❑ Meter(s)
E
❑ Service(s)
❑ Backflow(s) '
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
'
Capacity Charge
/Q56-nitatlon
❑" W.S.B.F.C.
❑ Temporary Construction Meter
❑ Tumon Charge
❑ Uncollected Account - Name
❑ Inspection Fee- Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
'
U
TOTAL S
Remarks:Q/%^('i
❑COpy to: -
-
Cash _
Water Servjce
Check
Money /JCJ
.`.
Order `
Cashier --4z—
'
CVWD-438111189)
Joe IPJVOICE
HAMMER PUMPING INC:
j P.O. Boz 2448
" CATHEDRAL -CITY, CALIFORNIA 92235-2448
(619) 360 7448
•
(619) 321-7448
..
DESCRIPTION OF -MATERIAL USED
CUSTOMER'S ORDER NO.
DATE ORDERED
-�7-Fj"
ORDER TAKEN BY
DATE PROMISED - O A.M. '
-
AD
O P.M.
BILL TO f—
C
f'
PHONE
Gt.h't �, cji.h 1
ADDRES?S�'� �/3 J Jam, C61
(J
MEQFI�fJI`� N
CITY
't
HE/L/\P/ERR
JOB N/� F A� LQ QTION v .
JC• SCJ L/(/
d"'J�AY WORK
'O�CONTRACT.
DESCRIPTION F�WORK J �\
/c, /10
-QJ-
O EXTRA
Out of Area Fee
� �
��D
J � wL•e,�r'
o `
Locating /.Opening Fee (per hour)'
-QUANT.
DESCRIPTION OF -MATERIAL USED
- PRICE
AMOUNT
Gallons
AD
Pumping -Fee per 1000 gal.
G�
,
Dumping Fee per 1000.gal.
S -a
_0e
Out of Area Fee
Locating /.Opening Fee (per hour)'
Size System:'
by
t
:'-
A SERVICE CHARGEOF $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
HELPERS Q
' TOTAL-
LABOR
I ereby ackn0ledgethe satisfactory TOTAL LABOR, =
.o letio �of_the above described work:
TAX
TOTAL
-
• SIGNATU -
TDATECPL7ET
O
G �
NOTICE TO'OWNER
Under the California. Mechanics Lien Lawany �t;actor, 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 ofthesafe 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 fife alien against your property if they are not
paid. Generally, the maximum time allowed for filing a claim or lien against your property is
nine,y (9W Days after,completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOUVAY 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. j
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.
r