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.