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0401-185 (PLBG)LICENSED CONTRACTOR DECLARATION , I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 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 Date 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. ( ) 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. (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 of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. f Date: Applicants 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 applicator 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,inspecttiion purposes.„y.•! Signature (Owner/Agent) \f` !' Date PERMIT # ' , BUILDING PERMIT f DATE .e OU.144* VALUATION >t u •�40 LOT ! TRACT JOB SITE ADDRESS ta; �ci:i 41.:,Ya�+ APN "' OWNE��Rpp CONT/RRAgC�TORR/�D.ESSI�GNNyE•R//tE;N61NEER rr//����,,77 �gpp�,�yy�,�p d,VCit���L!'t7:J.r WOODS � ` O 111 LMC. J741d0.+.L9d:.A'l 52-705 AVERIDAVIUA LA QMXI A CA 92253 USE OF PERMIT St 11T1(A13AtdOfaXn1XNT-SM-WK HOOK-UP VALUA.T10N l.t1a0. U P1,(iMUTAICtFt<I SEWER 101.000.419.000 $30,00 +. "all JAN 14 200-4 CITY OF LA .Qi3ii !A _. FINANCE AHEM, _. `Cil4F pb•3`6Y ffiaM-TOTA?, C:;OMMUC:'f."I:5N AM PLPN CIO $30.09 7.M13 PRE-PAiD FEES $0.00 T(KrAL.VKRJ.V= FFReS DUE NOW S.10.00 RECEIPT DATE 4f. J `t BY^r�h DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I 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 BLOCMALL APPROVALS POOLS - SPAS 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 I PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Pkrmbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral' Sewer Connection_ _ Pool Cover Encapsulation Gas Piping Gas Test Appliances Final 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 Final Utility Notice (Perm) COMMENTS: Cj �� D Y e �K,o: COACHELLA VALLEY. WATER DISTRICT CASH RECEIPT DETAIL NI; 99842 A1/// ,g: 1A jelnl c l Received From: otfkI^, I VVt!6/�t_'-eJI• Date:_/ % V q �1 / �� Address: _G 2 %1/^J/ �7A�."ILEW �T VILL I LA Q�� rs �1�3 Account No. 6 UoQ/ . 71k 0-1, Lot(s) /(0 &2— Tract �C Ae Service Address-% O.S A,0WI 4 VILLA - _ G.A. Code ❑ Meter(s) r $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge ..❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ InspectionFee- Tract -. 1 - Fee - ❑ Plan Check Fees Water / Sewer - , .•,.r r Tract - ❑ Bond Payment - A.D.'- Bond �. Assmt. ❑ Customer Deposit _. ❑ Other 00 TOTAL $ /1 Remarks: &ff/041 ME lCgpy to: - RDSIE Cash ,L/_/ /� Water Service Check i l Money l / Order /, (� Cashier i CV t D-438(11/69) --...— div,�i..t.:PL'k~i`3.�.,o�'�°do+.��''t"x - ... s ... �.'s���af��`?f�.�R.R+•�`__ ... Nnor. 1 d - wr.l tLt S. .y„ '�.;,.'_`w 62Gii 0 its MIKE WOODS �, Vit �' ,:� ,. m T 62706 AVENIDA VILLA `+� �' 1'q 1 • * 6.66/1220 g^ , a LA OUINTA A 922-3 `^ ' Dated ` s69 C 'µ S `.� .. C)`�-II ���! ��p�. •,�x�' "' ��.w._.•gik*'F�����lS��y��ri'`•�7Mfht''� !Mi 'Pay to fbe �i: V ✓(/L �t .x4.4 ' "Order..of C� t k �® Seoaky loolvma w.� s s7. lars 8owab ba*. x .... " Bank ofAlmle ca;'_ p t C-automRY), nie ' " Pelm S' un s Main Branch #0960 ].9G% % t` + AN �S z �� 668 South Palm Canyon Drlve Palm Spririgs CA 92262 (760).3_ -A-867 •For" w 2 200066 P:66 L 2-0848.3111056,3 L9ne �: "�;}i.`i. i+y*.;+"s +.,`� ,,'71/"''.4'1•s.`t'�,e,'��i'������`��''���,i?''�^.�,�t.. ,r. �c'`�£^.h*,�,7��(-tr r�� °� e�+) ,.�... F `;� I VALLEY WIDE PUMPING SERVICE -JOB INVOICE "Your Waste Is Our Problem" 8918 "Mj vUIw i.J PALM SPRINGS, CA 92262 (760) 322-2.400- (760) 347-3545 CUSTOMEP'S ORDER NO.' DATE ORDERED 0 RIDER TAKE) BY 'DAT C PROMISED n-A.M. BIL/ NE A15DRESS f C TA 'HELPER JOB NAME AND LOCATION 0 DAY WORK DESCRIPTION OF WORK0 "),111h N''o t3t 1- 4 /7. ✓17/ CONTRACT O -EXTRA 7 QUAINT. DESCRIPTION OF MATERIAL USED PRV—_E AMOUNT Gallons r102&o Pumping Fee per 1000 -gal. Dumping Fee per 1000 gal. Out of Area Fee Locating Opening Fee (per hour ty V 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 @ TOTAL LABOR I hereby acknowledge the satisfactory co tion of_thobove described wrk: C,,j TOTAL LABOR TAX R SIG N-A\E)j\� )t ATE COMPLETED TOTAL To Reorder Call NEBS CUSTOM'"printing service TOLL FREE I -600 -WS -6327 NESS, Inc., Peterborough, NH 03458, Ref. No: G 710703566 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 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. OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you.should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. ^� Contractors are required by law to be licensed and bonded by the State of California and to have a business license -from the City or County. They are also required by law' to put their license number on al. permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not ILensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer•and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's. compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks -.re especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Interna' Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor; only under limited conditions.. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' St:ue License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 777-7011 AI OWNER'S SIGNATURE/DATE DL7©S A vE�A\am PROPERTY ADDRESS 0YO PERMIT NUMBER(s)