14397 (PLBG)P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 51-960 Eisenhower Dr. LA QUINTA, CALIFORNIA 92253
Mr. Essi Shahandeh
Mailing
Address Sate
City Zip
La Quinta, 92253
Contractor
Denboer Engineering & Construction
Adur�ssl75 Aerros Court
Y Cite= CA 9223
& Classif. - A B 684563
Arch., Engr.,
Designer
Address
// LICENSED
I hereby affirm that I;am licensyed�
300) of Divl'sion 3 of .1he Business..
'-(619)327-220C
City
Lic. #
Tel.
State
Lic. #
IATION
er 9 (commencing with Section
d.my license is inifull force and
OWNER -BUILDER DECLARATION
I hereby affirm'tiiat I am exempt from the Contractor's License Law for the following .
reasgn: (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 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 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 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 or 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 contractors) (Icensed pursuant to the Contractor's License Law.) ,
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
I WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker' -Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol-c o. Company
Copy Is flied with the city.. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE '
(This section need not be completed ff 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: d, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or 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 property 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 .lo enter the above-.
mentioned property for inspection purposes. -
Signature of applicant Date
Mailing Address
City, State, Zip
No. 14397
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Seer Connect-
onnectSq.
Sq.Ft.
Size -
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$1 r 375.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
'
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 Permit l
Validated by:
Validation_ :
CO.ISTRUiiT10N ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWE ORo - G'jT
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
FRAMING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSULATION/SOUND
SO.FT.GAR ® 3/4c
HOUSE SEWER
FINISH GRADING
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE ORo - G'jT
ROUGH WIRING
DUCT 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
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
j/� FINAL INSP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
'HAMMER PUMPING INC, E �� JOB INVOICE
P.O. Box 2448 �.
CATHEDRAL -CITY, CALIFORNIA 922357-f448
I--, f% mf-., s i
\Vi^7/ JV V'/-TtV
- (619) 321-7448
`
CUSTOMER'S ORDER NO.
D EOR ERED
" q
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TOPHONE
N
ADDRESS
Pumping Fee per. 1000 gal. ,4
?s
CITY
HELPER
JOB NAMET/LOCA(Yj 6 4 �^/
(( ss L�ii J
QL U E— s 1 � vV&-r,_
(vV 1 /LJ C/++
0 DAY WORK
❑ CONTRACT
DESCRIPTION OF WORK
t ✓v ` l�'� l /
Dumping Fee per 1000 gal.
0 EXTRA
T 3
� � f� ..,�'�L � �Y � t S- � - f r5•w�, .:..•""..:7-�
� I t .t . i'
�. Su
QUANT.
-DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons `
J,660
Pumping Fee per. 1000 gal. ,4
?s
;wo
Dumping Fee per 1000 gal.
T 3
� � f� ..,�'�L � �Y � t S- � - f r5•w�, .:..•""..:7-�
� I t .t . i'
�. Su
� -
Out of Area Fee ,
Locating / Opening Fee (per houJ4r.. �.
4r,
Size System:
/
• i
A SERVICE CHARGE OF $20 WILL BE DUEj
ON ALL RETURNED CHECKS.? tJ
^
"
-XFINANCE CHARGE OF 11/2% PER MONTH, '18%'PER YEAR
WILL`BE'CHARGEO ON PAST DUE ACCOUNTS OVER 30 DAYS.
'
HOURS
7.8.`....^. LABOR J AMOUNT
TOTAL
MATERIALS
MECHANICS Q
HELPERS `-'Q
TOTAL
LABOR
•,
I hereby acknowleUe the satisfactory
completion o the`ove described work: TOTAL LABOR
fd.
/TAX
V
SIGNAT11
/
DATE COMPLETED ;1
til r rit''1
NOTAL
1 •,4;�• e
,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 a right 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.
4.
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 notica. A Preliminary Notice is not.a,lfen against your property. Its purpose is to
notify you of persons w o may have a right to file a lien against your property if they are not
paid. Generally, the ma mum time allowed for filing a claim or lien against your property is
ninety (90) Days after completion of your project:
7EGTi,1N QH ItIURSELF ANQ•YOtIR PROPERTY,
YOU MAY wis TO TAKE ONE OR MORE OF TH FOLLow'iNG STEPS: `"
1) Require that payments be made directly to subcontractors and material suppliers through
a joint "ntrol. Any joint control agreement should include the addendum approved by the.
Registrar of Contractors.
2) Issui joint checks for payment, made out to both your contractor and subcontractors or
material, -suppliers Involved- in the projebt..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 fife a claim against your property. in other types of construction this protection may Mill 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.