07-0593 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-000_0059=3—
Property Address: 52300 AVENIDA OBREGON
APN: 773 -255 -004 -4 -000000 -
Application description: PLUMBING
PropertyYZoning: COVE RESIDENTIAL
Application valuation: 250.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE ,(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
HENDRICKS MICHAEL & ROBIN
79080 CANTERRA DR
LA QUINTA, CA 92253
---------------------------------
Contractor:
Applicant: Architect or Engineer: Owner
Date: 2/22/07
y:..
LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty of perjury that I am licensed urider provisions of Chapter 9 (commencing. with -
I hereby affirm under.penalty of perjury one of the following declarations:
Section 7000) of, Division 3 of the Business and Professionals Code, and my License, is in full force and,effect. •
I have and will maintain a certificate:of'consenrto self -insure for workers compensation; as provided
License Class;.: License No.:
_
for by Section 3.700 of -the Labor Code, for the performance of the work for, which this permit is.
issued. -
'
Date: Contractor:'
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code; for the performance of.the work for, which this permit is issued.. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
' . I hereby affirm under• penalty. of perjury that I am exempt from thbtontractor's State License Law for the
Carrier Policy Number -
following reason (Sec: 7031.5, Business and Professions Code ,. Any city or county that requires a$ermit to
I certify; that; in the performance of, the work for which this permit is issued, I shall not employ any
�.
construct, alterAimprove,'demolish;'or repair any structure prior to its issuance, also requires the applicant for the
person in any manner so as to become.subject.to;the workers' compensation laws' of California,'
1:
permit'to file a signedstatement that he or she is licensed pursuant tothe provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of. Section
'License Law (Chapter 9,lcoinmenci, g -with Section 7000) of -Division 3 of the Business and Professions Code) or
- 3700 of the Labor Code, I'shall forthw' ,comply with hose provisions.
:that
R9 or she is exempt therefrom and the basis for the alleged exemption. Any violationof Section 7031.by
- //
anycapplicant for a permit subjects the applicant to a civil penalty of not more than five' hundred. dollars (S500b.:
Date:..G V j�'A, A,pplicant:- -
�.~
(•� 1 197as 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, Business•and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION.COVERAGE IS UNLAWFUL, ANDSHALL
Contractors' State;License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE -HUNDRED THOUSAND
and who -does the -work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION.TO THE COST• OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building ;or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, -AND ATTORNEY'S FEES.
oneyear of-,'completion,the,owner-builder will have the burden of provingthat :he or she did not build or
improve for.the-purpose of sale.)., -
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner. of,the,property;;am exclusively contracting with licensed contractors to construct the project_(Sec.
IMPORTANT Application ishereby made to, the Director of Building and Safety for a. permit subjectto the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. .
property who.builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the,Contractors"State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to; and'shill defend, indemnify and hold harmless the City
-
of La Quinta, its officers, agents and employees for any act or omission related to the work being
%_
performed under or following issuance of this permit.
/Da-te:'.c d'� `� r Owner*�..w
2. Any permit issued as a result of this application becomes null and void if work is not commenced
V �iEr'
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
' CONSTRUCTION LENDING -AGENCY
permit to cancellation.
.I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby author' a representatives
of this county to enter upon the above-mentioned property for inspeco urposes
Lender's Name:-
ry.Date �gnmure (Applicant or Agent):. - -
Lender's Address:
---""'
LQPERMIT
Application Number . . . . . 07-00000593
Permit . . . PLUMBING SEWER
Additional desc .
Permit Fee 30.00
Plan Check
Fee
.00
_
Issue Date . . . .
Valuation
250
Expiration Date 8/21/07
Qty Unit Charge Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments'
SEWER CONNECT/SEPTIC ABANDONEMENT
Fee summary Charged Paid
Credited
Due
----------------- ---------- ----------
Permit Fee Total 30.00
----- - ----
.00
----------
.00
30.00
Plan Check Total .00
.00
.00
.00
Grand Total 30.00.
.00
.00
30.00
LQPERMIT
City .of La QUinta.
Building U.Safety Division
[Permit
#
P. - Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012 .
Building' Permit Application and Tracking Sheet
Project Address:
'Owner's Name:
A. P. Number.
Address: 5a J tt�EC Qui
Legal Description:
, , Zi a
Cih'ST p: LR 4 0M STN C {� Q a a 5 �
Contractor:
Telephone:460
Address:
Project Description: SERVER C O(Jf�Tpt►�.
.
City, ST, Zip:
•
.S-• -j'.sc `T'P.tJK Ap�haDonif�E�li,
Telephone:
State tic. # :
City Lia #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
construction T �• Occupancy:
State Lie. #:
.
Proje ty (circle one): New Add'n. Alter Repair Demo
Name of Contact Person:
Sq. Ft i
# Stories:
# Units:
Telephone #9f Contact Person:
Estimated Value of Project:Q c
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd_
Reed
TRACKING
PERMIT FEES
.
Plan Sets.
Plan Check submitted
Item
Amount .
Structural Calcs.
Reviewed, reaidy for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cala.
Plans Picked.up ,
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
V Review, ready for correctioneissue
Electrical
Subcontactor List' .
Called Contact Person
Plumbing
Grant Deed
Plans picked,up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'a Review, ready for.correetionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date or permit issue
School Fees
.'1
Ll
n Total Permit Fees
r
r
OWNER/BVILDER INFOR1vIATION
Dear Property Owner:
An application for a building permit has been submitted in:.your name listing yourself as the builder of the property
improvements specified.
For your protection you should -be aware that as "Owner/Builder" you *..are the responsible party of record on such a
permit. Building permits are.not required to be signed by propertybWriers unless' they are personally performing their
own work. If your work is being .performed` by som6on*e.,oihei'.tl an yourself,' you may protect yourself from possible
liability if that person applies for the proper permit in his or her;nanie.
Contractors are required by law to be.licensed and' bonded by the" State of California and.to have a business license
from the City or County. They are also. required by law 'to put their: license number
''on all permits for which they
apply
If you plan to do your own work, with the exception of,varous trades that you plan to subcontract, you should be
aware of the following information for.your, benefit and protection, ,
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire; project, and such- persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and,federal Government as an employer and you are subject
to several obligations include State and Federal income .tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and, un employment compensation contributions.
There may be financial risks for you if you do not carryout these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations,4nder'Federal, Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific.information about your obligations under State
Law, contact the Department of Benefit Payments and`the';Divisiori of Industrial Accidents.
If the structure is intended for sale, property owners. who are not licensed contractors ace allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors;is to secure„an "Owner/Builder” building
permit, erroneously implying that the property owner is, providing his or her own labor and material. personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' :State License Board in your
community or at 1020 N. Street, Sacramento, California 95814. .
Please complete and return the enclosed owner -builder verification form so that=we can confirm that you are aware of
these matters. The building permit will not be issued until the, verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)
Cash
Check
Money rf'
Order
K
ir.
Water Service
Cashier
CVWD438 (1/05)
/ _+ JCOyAQC,HELLA VALLEY WATEq pISTRi&:CASH RECEIPT DETAIL
.
Received From:
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Address:�
.
Date: % - C�
Account No. CL L (!�' I ;
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U AJ % /4 f 7
Service Address i 4: ` l . C. �;,
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Tract---------------
❑. Meter(s)
;
G.A. Code
❑ Service(s)
$
❑ Backnow(s)
's
❑' House Lateral(s)
Cl Detector check(q)
❑ Meter Surcharge
.. Sanitation Capacity Charge
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❑ W.S.B.F.C.
00
❑ S.I.W.S.C.
❑ TemPorary Construction Meter
r..
❑ Tum on
.f .
. ❑ Uncollected Account - Name
_
❑ Inspection Fee _' Tract -
-
Fee _...
❑ Pian Check Fees Water / sewer
-
Trac _
' ❑ Bond -Payment -A.D.=
_
BondAsum
' ❑ Customer Deposit
...
❑ Other
..
Remarks:
TOTAL.:.
PY
i '-:J:••Y' j� i
` / ; r' G /l/ ter``. � � �
------------
Cash
Check
Money rf'
Order
K
ir.
Water Service
Cashier
CVWD438 (1/05)
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❑ WEST RANCHO BERNARDO & WORK ORDER NO.
WEST RANCHO PENASOUITOS (858) 484-2138
❑LAKE SAN MARCOS & LA COSTA (760) 726.6720 377108
❑ RANCH_ O SANTA FE & oUVEHAIN (858) 756.3396
DATE....3 .3 .................... JOB # ........... . �%G..................................
' a
FIXTURE MAIN LINE: FT ❑
CLEANED: TOILET -----------0
BATHTUB ---------0
TECH#1 .............. TECH #2 ..............................................
BATH SINK --------0' FLOOR DRAIN -----❑
-KITCHEN SINK - - - - -0 FLOOR SINK - - - - -0
LAUNDRY ---------0
SHOWER ---------- URINAL -----------0
ACCESSED VIA CAUSE OF STOPPAGE
❑ DRAIN ❑ CLEAN OUT ❑ ROOTS O GREASE
❑ VENT ❑OTHER ❑UNKNOWN TIME IN
❑ YES GUARANTEE ❑ NO ESTIMATE: My estimate for performing this work is: $
8 A.M. - 5 P.M. MON. THRU FRI. I I WORK ORDER AUTHORIZATION / WAVIER: I authorize Roto -Rooter to perform the described services and I agree to pay the amo
INITIAL FOLLOWING:
unts
Indicated. I understand that Roto -Rooter is not responsible for broken, settled, rusted, deteriorated, or lead pipes, fixtures, or clean
outs and any damage resulting from cleaning or repairing such lines.
I have asked Roto -Rooter to provide services, Under Section 1689.13 of the California Civil Code, In order to induce Roto -Rooter to
provide these services; 1) Initiated negotiation and contract; 2) executed this contract in connection with the making of emergency
or immediate necessary repairs or services necessary for the Immediate protection of persons or personal property detailed on this
Invoice; and 3) 1 expressly acknowledge and waive the right to cancel this contract within three or seop business days, whichever
applies. .w_ _ .
(PRINT NAME) (SIGNATURE)
COMPLETION i acknowledge completion of the above described work which has been done to my complete satisfaction.
A. The serviceman discussed Roto -Rooter products with me.
B. I have been advised additional lines cleaned at this time are half prices.
C I have been advised that running my main line from a 3- roof vent is
improper access and can only be given a 10 day guarantee, a 2' main line has a
zero guarantee. In order to get a 120 day guarantee a cleanout must be installed.
CLEAN UP
CE3 IXCELLENT ❑SATISFACTORY ❑ POOR
CUSTOMER COPY
AREA DRAIN -------0
OTHER ❑
TIME OUT
DRAIN CLEANING
ADD'L FOOTAGE C
ADD'L FIXTURES C
PLUMBING LABOR
PARTS
PRODUCTS/TREATMENT
VIDEO INSPECTION
HYDRO-JETTER
MINIJETTER��
LINE/ LEAK LOCATION
PU SEPTI REASE
OTHER �E_
TAX
TOTAL
PAYMENT RECEIVED
CC EXRDATE APPROV #
I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I
am agreeing to all charges incurred on this invoice and that the work was completed to my satisfaction.
Cardholder Signature X
SEE REVERSE FOR TERMS & CONDITIONS ❑ CASH' ❑ BILLXCK #//-?0 ❑ CREDIT CARD/TYPE
D HEMET (951) 6588541
❑ LAKE ELSINORE (951) 8142312 ❑ FALLBROOK & BONSALL (760) 728-7497
ROTO
D BANNING(951)922-9491
O RANCHO/TEMECULA(951)699-0555 ❑ OCEANSIDE, CARLSBAD (760) 722.3155
�OOTERtt
❑ PERRIS (951)`657-9852
❑ REDLANDS/YUCAIPA (909) 797-86797.8697.,; VISTA &TRI -CITIES AREA (760) 726-6260
❑ BEAUNIONT (951) 845.3338
❑ PALM SPRINGS/DHS (760) 322.2622 • ❑ ENCINITAS & CARDIFF (760) 753.2674
Plumbers
❑ SUN CITY (951) 679-8919
❑ INDIO/PALM DESERT (760) 346-1736 C3 DEL MAR & SOLANA BEACH (858) 481-1633
Division of RotoCo., Inc.
796 N. STATE STREET . HEMET, CA 92543
License Number 422155 • Federal ID Number: 33-0475032 Toll
Free: (800) 491-7686 • Fax; (951) 652-9515 • 1-800 GET ROTO (438-7688'
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❑ WEST RANCHO BERNARDO & WORK ORDER NO.
WEST RANCHO PENASOUITOS (858) 484-2138
❑LAKE SAN MARCOS & LA COSTA (760) 726.6720 377108
❑ RANCH_ O SANTA FE & oUVEHAIN (858) 756.3396
DATE....3 .3 .................... JOB # ........... . �%G..................................
' a
FIXTURE MAIN LINE: FT ❑
CLEANED: TOILET -----------0
BATHTUB ---------0
TECH#1 .............. TECH #2 ..............................................
BATH SINK --------0' FLOOR DRAIN -----❑
-KITCHEN SINK - - - - -0 FLOOR SINK - - - - -0
LAUNDRY ---------0
SHOWER ---------- URINAL -----------0
ACCESSED VIA CAUSE OF STOPPAGE
❑ DRAIN ❑ CLEAN OUT ❑ ROOTS O GREASE
❑ VENT ❑OTHER ❑UNKNOWN TIME IN
❑ YES GUARANTEE ❑ NO ESTIMATE: My estimate for performing this work is: $
8 A.M. - 5 P.M. MON. THRU FRI. I I WORK ORDER AUTHORIZATION / WAVIER: I authorize Roto -Rooter to perform the described services and I agree to pay the amo
INITIAL FOLLOWING:
unts
Indicated. I understand that Roto -Rooter is not responsible for broken, settled, rusted, deteriorated, or lead pipes, fixtures, or clean
outs and any damage resulting from cleaning or repairing such lines.
I have asked Roto -Rooter to provide services, Under Section 1689.13 of the California Civil Code, In order to induce Roto -Rooter to
provide these services; 1) Initiated negotiation and contract; 2) executed this contract in connection with the making of emergency
or immediate necessary repairs or services necessary for the Immediate protection of persons or personal property detailed on this
Invoice; and 3) 1 expressly acknowledge and waive the right to cancel this contract within three or seop business days, whichever
applies. .w_ _ .
(PRINT NAME) (SIGNATURE)
COMPLETION i acknowledge completion of the above described work which has been done to my complete satisfaction.
A. The serviceman discussed Roto -Rooter products with me.
B. I have been advised additional lines cleaned at this time are half prices.
C I have been advised that running my main line from a 3- roof vent is
improper access and can only be given a 10 day guarantee, a 2' main line has a
zero guarantee. In order to get a 120 day guarantee a cleanout must be installed.
CLEAN UP
CE3 IXCELLENT ❑SATISFACTORY ❑ POOR
CUSTOMER COPY
AREA DRAIN -------0
OTHER ❑
TIME OUT
DRAIN CLEANING
ADD'L FOOTAGE C
ADD'L FIXTURES C
PLUMBING LABOR
PARTS
PRODUCTS/TREATMENT
VIDEO INSPECTION
HYDRO-JETTER
MINIJETTER��
LINE/ LEAK LOCATION
PU SEPTI REASE
OTHER �E_
TAX
TOTAL
PAYMENT RECEIVED
CC EXRDATE APPROV #
I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I
am agreeing to all charges incurred on this invoice and that the work was completed to my satisfaction.
Cardholder Signature X
SEE REVERSE FOR TERMS & CONDITIONS ❑ CASH' ❑ BILLXCK #//-?0 ❑ CREDIT CARD/TYPE
CONDITIONS AND EXCLUSIONS
Roto -Rooter Service & Plumbing Co. guarantees the services performed as set forth in this invoice to be free from defect in materials or
workmanship"for the applicable `time period stated above. If within the Guarantee Period a drain stoppage or other defect in the repair of plumbing
fixtures or plumbing parts'installed by Roto -Rooter Service & Plumbing Co. occurs, Roto -Rooter Service & Plumbing Co. will clear the drain stoppage
or, repair or replace (at Roto -Rooter Service & Plumbing Co.'s option) the plumbing fixture or plumbing part previously installed at no cost to customer,
subject to the following exclusions and limitations:
1. This Guarantee applies -only to the specific sewer lines cleaned, or plumbing fixtures or plumbing parts supplied and installed by Roto -Rooter
Service & Plumbing Co.
2. Roto -Rooter Service & Plumbing Co. must receive notice of the defect within the Guarantee Period.
3. This Guarantee does not apply to:
a. Multi Unit Dwellings sewer and drain lines, plumbing fixtures or plumbing parts.
b. Materials furnished or work performed by other than Roto -Rooter Service & Plumbing Co.
c. Drains, sewer lines, plumbing fixtures and plumbing parts which have been misused, abused, damaged or modified by others;
d. Drain or sewer line stoppages caused by foreign objects, including but not limited to sanitary articles, paper towels, toys, etc.; or
e. Sewer lines which are settled, broken, offset deteriorated, damaged or improperly or illegally installed.
f. Drains, sewer lines, plumbing fixtures on septic systems.
g. Commercial accounts.
4. The Guarantee Period commences on the date or original service and shall not be extended by subsequent services or repairs made pursuant to
the terms of the Guarantee. The Guarantee hereunder extends to the customer invoiced for the services and is not transferable.
5. Roto -Rooter Service & Plumbing Co.'s liability hereunder shall be limited to recleaning of drain or sewer stoppage (Max. two repeat visits) or
the repair or replacement of defective plumbing fixtures or plumbing parts: Roto -Rooter Service & Plumbing Co. shall not be liable for (1) Incidental or
consequential damages; (2) Water or other damage; (3) Loss of use; or (4) Loss of anticipated benefits or profits, any of which result from the furnishing
of services or products, or from the breach of the Guarantee, even if Roto -Rooter Service &. Plumbing Co. knew of the likelihood of such damages.
6. __Any implied warranty of merchantability, or fitness for a particular purpose of use, shall be limited to the duration of the foregoing written
guarantee. The foregoing written guarantee is the customer's sole and exclusive remedy and in lieu of all other guaranties and warranties, express or
implied, written or oral. This guarantee may only be modified in writing, signed by an officer of Roto -Rooter Service & Plumbing Co.
7. This guarantee does not apply in the event customer breaches any of the Terms and Conditions of service, including but not limited to timely
payment of all charges.
8. Collection. Owner agrees to pay all collection fees and charges including but not limited to all legal and attorney fees that resultshould Owner
default in payment of this contract. Overdue accounts are subject -to' interest charged at the,rate of 18% per annum.
9. Legal Fees. In the event litigation arises, out of this contract, prevailing party(ies) are entitled to all legal, arbitration, and attorney fees. The
court shall not be bound to award fees based on any set, court fee schedule but shall if it so chooses, award the true amount of all costs, expenses and
attorney fees paid or incurred.
TERMS: NET 10 DAYS. A FINANCE CHARGE will becomputed on the unpaid balance by a single period rate of 1-1/2% per month, which is an
ANNUAL PERCENTAGE RATE OF 18%. �• y,
"State law requires any one who contracts to do construction work to be licensed by the Contractors State License Board in the license category in which
the contractor is going to be working - if the total price of the job is $300 or more (including labor and materials).
Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license. The Contractors
State License Board may be unable to assist you with a complaint. Your only remedy against an unlicensed contractor may be in civil court, and you may
be liable for damages arising out of any injuries to the contractor or his or her employees.
J
You may contract the Contractors State License Board to find out if this contractor has a valid license. The board has complete information on the history
of licensed contractors including any possible suspensions, revocations, judgements and citations. The board has offices throughout California. Please
check the government pages of the white pages for the office nearest you or call (800) 321-CSLB for more information."
t.J