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15063 (PLBG)P.O. BOX 1504 No.. 15-06 3. Address 52-6330 ' Ave. villa LA QUINTA, CALIFORNIA 92253 Owner fi+i�.,. cc St. ri�i'3E3Y' FSiYt('3t:� • ,� , Mailing BUILDING: TYPE CONST: OCC: GRP. Address Satire .City Zip ITel. .La. Qu .La. CA 2a53 .. Contractor Denbo6k' Engineering & Construction Address X�68-175 Serros Court C I tl��1 8 . �:�qyZi90A 9223''4*' 22.3 Tel 127-2200 State Lic. A 684.563 City 3577 & Classif.. Lic. # Arch_ Engr., _. . Designer Address TeL A.P. Number Legal Description Project Description Sewer Connect Sq. Ft. Size New ❑ No.. No. Dw Stories Units Add fl '• Alter n Rebair f7 -Demolition ❑ City Zip State Lic. # Electrical' -Plumbing LICENSED CONTRACTOR'S'DECLARATION I hereby affirm that lr am licensed under provisions -off 6hapier.9 (commencing with Section 7000) of Divis�i�6n 3 of the Business and Professio ode, and my license is in/full f rlcTe and effect. fit i�/% -9� Grading Driveway Enc. GN TU �•�y ✓ TATE ' " I 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 of, 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 rile '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 rive hundred dollars (8500). ❑ 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 Estimated Valuation00 7n0' : $ i t) • - - PERMIT Plan'Chk. Dep. - Plan Chk. Bal. COr1St 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. If, however, the building - or Improvement is sold within one year of completion; the owner -builder will have the burden of proving that he did notbuild or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting. with licensed contractors to con- • 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 such projects with'a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec: B. & P.C. for this reason ZONE: Mech. - - Electrical' -Plumbing S.M.I.- Grading Driveway Enc. Date owner Infrastructure Rear Setback from Rear Prop./ane: WORKERS' COMPENSATION DECLARATION I hereby affirm that l have a certificate of consent' to self -insure, or a certificate of Worker's Co pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) POIh�crY�_ Company ' W.,Copy is filed with the city, O Certified copy is hereby furnished. ' CERTIF AT Side Street Setback from Ce” r Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -UP TO ONE HUNDRED THOUSAND DOLLARS IN ADDITION TO THE COST OF COMPENSATION„ TOTAL AMOUNT 30.00 IC E OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one. hundred dollars ($100) valuation - or less.) - I certify that in the performance of the work forwhich.lhis permit is issued, I. shall not employ any peon in any manner so as to become subject -to the Workers' Compensation Laws of Cal ifrs ornia Date ��Owner NOTICE TO APPLICANT: ff, .'after making •• this Certificate, of Exemption' you should • become ZONE: .:BY: - subject to the Workers' Compensation provisions of 'the Labor .Code,• you must forthwith comply with such provisions or this permit shall be deemed revoked. • Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop./ane: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND - Side Street Setback from Ce” r Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -UP TO ONE HUNDRED THOUSAND DOLLARS IN ADDITION TO THE COST OF COMPENSATION„ / ($100,1X1O), Side Setback from Properl @- e DAMAGES AS PROVIDED FOR IN SECTION 3706°OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. FINAL DATE i INSIDE OR This is a buildiri g permit when property filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. y �y • I certify that I have read this application and state that the above information is correct: Issued by: Date Permito n / 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-. �nQ mentioned property for inspection purposes.. Validated by:. \\\ n Signature of applicant Date' Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. p FOR. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS 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 FINAL INSP. SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® lAc HOUSE SEWER VENTILATION 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 S AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER R iC ROUGH WIRING DUCT WORK ROCKSTORAGE 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL HAMMER PUMPING INC. JOB INVOICE P.O. Box 2448 CATHEDRAL CITY, CALIFORNIA 92235-2448 (6191 360-7448 (619) 321-7448 PRICE AMOUNT CUSTOMER'S ORDER NO. DATE ORDERED Pumping Fee per 10.00 gal. ORDERTAKENBY DATE PROMISED ❑ A.M. P.M. BILL TO / �M Sd —,too PHONE ADDRESSM CHAZA CITY _ ' _ �. HELPER . JOr';Z&I7 �J.QN ec p� y( V V t ' ll//r � C MrWORK ❑'CONTRACT -DESCRIPTION F WORK � �j� ❑EXTRA - � C^- � c urf QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT /,50 0 Gallons Pumping Fee per 10.00 gal. &- Dumping Fee per 1000 gal. Sd —,too Out of Area Fee Locating / Opening Fee (per hour). Size System: � c urf A SERVICE CHARGE OF $20 WILL BE DUE- UE ON ALL RETURNED CHECKS. ON -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 hereby acknowledge the satisfactory completion of the abov k escribed work_;,, TOTAL LABOR TAX , ' SIGN URE DATE COMPLETED ,3( t TOTAL o? Q ®i i - NOTICE TO OWNER UndeF-the California Mechanics Lien Law.any contractor,.subcontractor9,lstborer?'supplier or other person who helps to improve your property, but is rtot'paid for -'his/her work or supplies, has a right. to enforce a claim against your property. This means that ager a court hearing, your property could be sold by a court officer and the proceeds of the sate used to satisfy the indebtedness. This ban happen even if you have paid your contractor in full if the subcontractors, laborers or supplibrs 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, "Prelimir fary Notjce." Original (or prime) contractors and laborers for wages do not have to' provide this notice. A Preii 6 ry Notice is not a lien against your property. Its purpose is to notifyyou of persons who Z have a right to file a lien against ourproperty if the are not' Y P Y. 9 9 Y Y paid. Generally, the maximum time allowed for filing a claim or lien against your property is ninety (pO) 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 FOLLbWIhG STEPS`. r" 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 wast made. On projects involving improvements to a single family residence ora duplex owned by individuals, the persons signing these releases lose the right to file a claim against your property. In other types ofconstruction this protection may still be important, but may not be as complete. -TO PROTECT YOURSELF UNDER THIS OPT16Hr Gw t _.MUST BE CERTAIN THAT ALL•MATERtAL SUPPLIERS, SUBCONTRAbTORS OR LABORERS HAVE SIGNED.