15047 (PLBG)P.O. BOX 1504 y
Building 53-677Ave. Herrera 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Toni, Grut2
Mailing
Address Sate
City Zip Tel.
La Quinta,. G 92253 .
Cofjga1t-§tar Construction
—T.X. Box' 542
City Tel.:
4athedrai Ci yZip, CA 9223 32$-0898
State Lic. City
& Classif. A-475515 Lic. # 762
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
,/7000) lot Division 3 of:the Business and„P„rofessions Code, and my, license is�in.full force and
\ r �.�'.- ��..�..�---•
SIGNATURE - DATE
j -
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 or, county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
1 requires the applicant for such permit to file 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 or 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 penally of not more than rive hundred dollars ($500).
O 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
Professions 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,
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 -budder wig have the burden
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-
struct the project. (Sec. 7044, Business andProfessions 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 contractor(s) Licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Dale Owner
WORKERS' COMPENSATION DECLARATION
I- 1 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
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 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.
Date Owner
NOTICE TO APPLICANT, If, after making this Certificate or Exemption you: should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,010), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR .IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above. information is correct.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
No: 150.47
BUILDING: TYPE CONST. • OCC: GRP.
A.P. Number
Legal Description
Project Description Sewer Connect
Sq. Ft. No. No. Dw.
Size - . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $ 1 , 200.00
PERMIT
AMOUNT
Plan. Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
3fl . HiQ
REMARKS
ZONE: . BY:
Minimum Setback Distances:.-
-Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side, Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
r
Issued by, Date 11 rmit
Validated by: n
Validation:
A
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIIVv FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
Of
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWE O
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
CERT. OCC.
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.
Of
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE O
ROUGH WIRING
AUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
n
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
, FINAL INSP.
0mloy
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 SIONATURESIINITIALS
GARDEN WALL FINAL
COACHELLA•VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Date
_-i CI,
Tract J •� • ff �1
G.A. Code
S
TOTAL
1
Remarks: t .111 \ rn E.c l n U� r�d ✓1
1
006Y to:
Cash
Check14
Money
Ober
[+7
Water
(11189)
` Wo
Received From: L1 ,A
Address: ti — �o '�V
)AC .i L 0.
Account No.(�
Lolls) G 1•
Service Address !aVV, Q
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Checks)
❑ Meter Surcharge
"nitation Capacity Charge
` 55
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee -Tract -
Fee -
❑ Plan Check Fees Water 1 Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
Customer Deposit
P❑
❑ OUier
Date
_-i CI,
Tract J •� • ff �1
G.A. Code
S
TOTAL
1
Remarks: t .111 \ rn E.c l n U� r�d ✓1
1
006Y to:
Cash
Check14
Money
Ober
[+7
Water
(11189)
'HAMMER PUMPING INC., to
JOB INVOICE
P.O. Box 2448 4 �71
CATHEDRAL CITY, CALIFORNIA 92235-2448
rai ot ian_7AAQ
jv a � j . Ww I �
(619) 321-7448
DESCRIPTION OF MATERIAL USED
CUSTOMER'S ORDER NO.
DA E RDERED
X G `�1�
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
ti
HILL r i S �
0.
PHONE
ADDRESS
Pumping Fee per 1000 gal. l �
MEC�iQNIC
1Lv) C -t.
CITY
G2
HELPER
)B NAMF.iAC1D
J ✓L -$S CATI
Ake o-
AAT9
CRI ON OF WORK
�H1
/
WeiEXTRA
❑ONTRA
00
,UANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
000
Gallons
' 00 D
Pumping Fee per 1000 gal. l �
�S r
�S`
G2
/QQD
Dumping Fee per 1000 gal. K
S"Q�
S`6
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
tc0 1A
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
HELPERS Q
TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
completion of the above described work:
TAX
SIGRATURE -
/,�/yll
TE COMPPLET!7
ptCj YTOTAL
NOTICE TO OM(NIEW
Under,we California Mechanics Lien,Law any contractor, subcontractor,.laborer,-supplier
or -other -person who helps to improve your propertytbut is not paid for his/her work or
supplies; has a right to enforce a claim against your property: This means that after`aicourt
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,laborerinvolved In'that portion of the
work for which payment was'made.'On projects involving improvements to a single family
residence or a duplex owned I;y 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 A'LL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.
4