15072 (PLBG)�y
F
T,i-tlt 4 4 Qum&
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 54255 Ave. 'Herrera LA QUINTA, CALIFORNIA 92253
Owner Mr. & Mrs. Bruce Pelletier
Mailing
Address ,'game
City Zip Tel.
La Quinta.. CA 92253
Contractor
Denboer Engineering & Construction
Address
6�3-37 grog court
Cathedral City,IpCA 92234 Te327--2240
State Lic. A 604563 City 3577
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARAT-ON
I hereby affirm thahl am licensed under provisions of Cha
000) (commencing with Section
70�) of Division 3'of the Business and'Professions Codec"arid my license is in full orce nd
effect
��
SIGNATURE .!°`-�.+�`-^'�"" ! DATE
m
WNEP BUILDER DECLARATION
I hereby affirm that I exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness 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
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 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 five hundred dollars ($500).
❑ 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 -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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
$.G py Is filed with the city.. ❑.Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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. ff,. after making this Certificate of 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 ($100,000), 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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
LDING: TYPE CONST
P. Number
No. 154?2
OCC. GRP.
Legal Description
Project Description Sewer Comiect
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ " Repair:❑ Demolition ❑ .
Estimated Valuation $1,700.00
1
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
34.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.�Line�
Side Street Setback from,Center Line
fl,.
Side Setback from Propetty. Ine<`,"l'
FINAL DATE INSPECTOR 7,4 V ��
Issued
Validated by:
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CARP. SO. FT.
TEMP. POLE
WALL SO. FT. ®
GROUT
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP .
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSULATION/SOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES��FEE
FINAL INSPECTION �S
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
EW R
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
c��/ y/�Q
FINAL INSP .
FRAMING
FINAL INSP.
ROOFING
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION �S
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA .92235-2448
ray of 1An-7AAQ
%v 1 — i —
(619) 321-7448
QUANT.
CUSTOMER'S ORDER NO.
DAT ORDERED
—a (-
AMOUNT
ORDER TAKEN BY
Gallons
DATE PROMISED ❑ A.M.
000
❑ P.M.
BILL TO
00
PHONE
�t
ADDRESS
Dumping Fee per 1000 gal. k(
S'��
MEN C /'
1`
CITY
t.
HELPER
JOB NAME A e CATION
�� —ZJ P I%��
Gl
AY WORK
1 J /�
✓� VLl
DESCRIPTION (1
^
❑ CONTRACT
❑EXTRA
L'W`OR�� ,
Locating / Opening Fee (per hour)
o or -
K -
LAg
I
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
'000
Gallons
000
Pumping Fee per 1000 gal.
00
Dumping Fee per 1000 gal. k(
S'��
5`Q
oe
t.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
fCF r r
t
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 acknowle e't"' s �Sfactory TOTAL LABOR
completion of the�ab ve a fribed work:
TAX
SIGNATURE JTCOMPLETED
a
TOTAL
133
NOTICE TO OWNER .
Under the California Mechanics Lien Law any contractor, subcontractor, Jaborer,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 A'� er a court
hearing, your property could be sold by a court officer -and the proeeds 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 fife 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 nota 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 Jnclude 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 QPON 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.