14393 (PLBG)Building
Address
Owner
} P.O. BOX 1504 N o . 14393
9.3
51-860 Eisenhower Drive LA QUINTA, CALIFORNIA 92253
Mr. Mrs. Barajas
Mailing" BUILDING: TYPE CONST. OCC. GRP -
Address Sane .
Cite Quinta., C zip92253 Tel.
Contra for
Ben�Mer Engineering & Construction
AVEF-SS175- Berros Court
ctathedral Cit'; CA 92234'Teri.619 j 327-2.200
State Lic. City
& Classif.. A B 684563 Lic. #
Arch.,•Engr.,
Designer
Address Tel.
City Zip State
Lic. # -
LICENSED CONTRACTOR'S DEbLARATION
hereby affirm that I am licensed under Provisions�f,dhapter 9 (commencing with Section
,1�of Division 3 of the BusinAss and Profession Code, -and my license is)in fuit'force and
. eTfect. RX L Ii*(er1 i �� F 3 /irr i -1/7, s
OWNER -BUILDER DECLARATION
I hereby affirm th t 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, alter, 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 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 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 and .Professions Code: The Contractor's License Law
does not apply to an, owner of property who builds or improves thereon, and who contracts dor
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I 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�df Company
W, opy is tiled with the city. ❑Certified copy is hereby furnished.
4.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE•
(This section need not be completed I/ the permit is for one hundred dollars ($100) valuation
Of less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any pornierson' in any manner so as to become subject to the Workers' Compensation
Laws of Califa
Date Owner
_ NOTICE TO APPLICANT: ff, after making. this Certificate of, Exemption you should become
i subject to the Workers' Compensation provisions o/ 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 ($100,0)0), IN ADDITION TO THE COST OF.COMP.ENSATION,-
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES. -
Ttiis 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
A.P. Number
Legal Description
Sewer Connect
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add.❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 41A30.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
.Const.
Mech.
Electrical
ec
Plumbing `r
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 30.00
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
Issued by:
Date P• mit
J
Validated by:
�I
Validation:na
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. _�- o� SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
EWE OR S
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. SO. FT.
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
_
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® VAc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE Ll
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
EWE OR S
ROUGH WIRING
DUCT WORK
ROCK STORAGE
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.
AI-
I J sdot"'l
FINAL INSP.
FRAMING
FINAL INSP. 3 `J�
7
_
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
1c'1n'Icn -Fwwo
ws�/ vvv-i �w
(619) 321-7448
If DESCRIPTION OF MATERIAL USED
CUSTOMER'S ORDER NO.
DATE ORDERED
-:L— 13 - 1? 5 -
ORDER TAKEN BY
DATE PROMISED ❑ A.M.
❑ P.M.
BILL TO 04
PHONE
ADDRESS
Pumping Fee per 1000 gal.
NIC
CITY
HELPER
JOB NAMEr LOCV%O S�
((��
�/ /1
❑ DAY WORK
DESCRIPTION OF WORK �� /•1� 1 •_
WO
O CONTRACT
❑EXTRA
U�
QUAINT.
If DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons
66V
Pumping Fee per 1000 gal.
WO
Dumping Fee per 1000 gal.
U�
Out of Area Fee
Locating / Opening Fee (per. hour)
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 TOTAL LABOR
completion of bove described work:
TAX
SIGNATU
DATE COMPLETED
r.
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 aright 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. ;