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PLBG (0210-103)77275 Calle Madrid 0210-103 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (c&nmencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 6 r" 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C : for this reason, /7 ate _ j, r. a Signature of Owner If iY, /'/ 561X _ H.« WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) 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 insurance: carrier & policy no. are: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become' subject to the workers' compensation provisions of Section 3700 of the Labor Code; I shall forthwith comply with those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ` f ► . ,:Signature (Owner/Agent);.fix=•w* 1 Date PERMIT # BUILDING PERMIT F 10-103 VALUATION &4W.00 LOT TRACT DATE " 10/9iT12 JOB SITE ADDRESS 77.275 CId",i`Ird,r tMD APN OWNER CONTRACTOR/DESIGNER/ENGINEER 'WENDRU, c MEN ra' sta3♦ - Ir r : . 77.275 Ct1L.f;JE" MAD:t M c1t, 92253 USE OF PERMIT :3A,PTICABANi CfXM*4T; `r'EW21t HOOK-UP `Oi,ALt`ATION' 9rf ,G4 Ls, cos' 't, F C J:1`Ikeat : iTO'1;I:t?.N 40D.00 y;ey j` ' ' 1 . ; r Tp A` ,Q' y, rF F Tii.F.i.dl Al di :7d LL E lT1AK,f. YF1i`RY I'I,UMDING l EZ . SEWER 301 000-419-000 i CITY OF LAQUINTA I FINANCE DEPT, i RIB -TOTAL CQyq °. Urr,1.I=T0fZ P+ AL :;.k R -M -...m y IahaAN YOTAL;MIMM SEs :'R s 1101V $301W RECEIPT DATE BY DATE IN D,,,r INSPE ^ , ! $ c INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test final Gas Piping PLUMBING APPROVALS Gas Test Electric Final W • e Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: I I } :_ OOACI1El :YALCV?wA*01 DISTRICT CAOH R r3 kPI AEfAII I W-4+ 1► tecalvedFrorn:_ r [ t kddf 89; - -e• , k000um-No, a - e I:Qti s) Tract aryl Address'' G.A.Cod® is V J SoMce(s) ,N '"Etiwcktlow(s) • 7 H iuse4Merol(s) 7 Otector Chsok(s) J, M}t4t.9uro rys Y , Ijj i nttatlon Qapacli,y nh* ` T °ora Can tr coon Meter ` - . ,• Q , rY 9 u ` ' .. .. T;rn on Charps a 7 Un 3- inl nallaoted•A6oaunt - Nartte 000on Fee -Trpo — a i E 1 I Pad h Ch iokfoo-o for d itwet . , ' R . ' Tract- V 1 9' nd 9agmsnt - A.D. Asimt, -- C stome'r Q?goslt 1l Ot.or , li F TCTAI; S marks: ' oQFy: y to ;.ash. i Water ServloQ shack - E 1,T To n .. _ . ; • t . ?rd s. Cashlor `E.' a` " CVW© 439(1t1E9) I I 0Q)27M= RooTEI ® ,Plumbers w - 1D :, Inc. I Irpnsp Ni rmhpr'4 7TriFi • Fa i `rnIV) Ni rmM ❑'HEMET (909).658-8541 ❑LAKE ELSINORE (909) 674-2312 r p BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555', j' .WORK ORDER NO. •2 2*8 7-2 4 a,r ❑ BEAUMONT (909) 845-3338 -❑ REDLANDS/YUCAIPA (909) 797-8697 ': ' ❑ PERRIS (909) 65.7-9852 ❑`PALM SPRINGS/DHS (760) 322-2622 jQ ''t 214pz El SUN CITY (909) 679-8919 ElINDIOIPALM DESERT (760) 346-1736 f DATE t_Y - JOB # _ 1 ... •, . 796 N. STATE ST. • HEMET, CA 92543' r Toll Free: (800) 491-7686 Fa: (909) 652=9515 rr L TECH#1 ''TECH #2 1-800 GET ROTO (438-7686) ' - 3475032 _ - FIXTURE, MAIN LINE:., FT',❑ BATH SINK*-: ------❑• FLOOR DRAIN PURCHASE ORDER # + CLEANED', TOILET -'- - - - „- - -0 ,'s KITCHEN SINK -.- - - -❑ FLOOR SINK - - - - - - -❑ JOB AD E$$._ (3`S Lpft ` — M. b CITY STATE ZIP 1 - rCOU TES=' INSPECTIONO ACCESSED VIA ODRAIN CLEAN OUT SIXC1VENT BATHTUB ----------- 11 LAUNDRY --- :•----- D ' SHOWER = - - - -❑' URINAL' ------- F ❑ 0 YES GUARANTEE NO 8 A.M. - 5 P.M. MON. THRU FRI. TIME IN _ CAUSE OF STOPPAGE DRAIN CL *ROOTS OGREASE * OTHER 0 UNKNOWN t.I URE N y MAIN LINES OK NEED' $ 1AUTH. QTY. 1 PART NO. It DESCRIPTION / REMARKS / REPAIRS NEEDED PRICE TOILET PLUMBING LABOR 1 PARTS BATH TUB VIDEO INSPECTION HYDRO-JETTER MINI JETTER L LINE/ LEAK LOCATION SHOWER y 1 OTHER BATH SINK TAX ; TOTAL 1 . r -r11—` KITCHEN SINK DISPOSAL . LAUNDRY,URINAL ",r . - . . _ ---_:. -v= = _, •--- --- --- , , FLOOR DRAINf` FLOOR SINK I I r ' AREADRAIN WATER HEATER- WATER ' --- -• _ ...__ E : Ems .. -,. ' C O REB. FT PLEASE INMAL THE FOLLOWING: The serviceman dlscussed1R&o!Rooter products with me ! AREA DRAIN - -.- - -- -❑ OTHER El TIME OUT tANIIVC7 y ( ADD'L FOOTAGE j ADDT FIXTURES A PLUMBING LABOR 1 PARTS PRODUCTS/TREATMENT VIDEO INSPECTION HYDRO-JETTER MINI JETTER LINE/ LEAK LOCATION T PUMP SEPTIC -/GREASE --_ y 1 OTHER TAX ; TOTAL 1 . r PAYMENT RECEIVED ❑ CASH BILL &K# . ❑ CREDIT CARD/TYPE B. I have been advised additional lines cleaned at this time are half priced t , w CC EXRDATE APPROV. # C. I have been advised that running my main line from a 3- roof vent is t I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I improper access and can only be given a 10 day guarantee, a 2- main line has a am agreeing to all charges incurred on`this invoice and that the wor as completed to my satisfaction. zero guarantee. In order to get a 90 day guarantee a cleapout must be installed. t wA 'R OF RIGHT TO Cardholder Signature X y.. ti IVE CANCEL. - Pursuant to Section 1689.13 of the California Civil Code, I acknowledge and hereby waive my right to cancel the sale within three days and acknowledge - that the products and services rendered hered6der ore emergency repairs., Signature ADDITIONAL TERMS AND CONDITIONS CONtINED ON N THE REVERSE SIDE HEREOF .i i Acknowledgement Completion CUSTOMER COPY CCS INIDMONS AND IEX(CILUSEMS Roto -Rooter Service & Plumbing Co. guarantees the,services performed as set forth in this invoice to be tree from defect in materials or workmanship for the applicable time p riod stated above. If wichin the Guarantee Period a drain stoppage or other defect in the repair of plumbing fixtures or plumbing Darts installed l y 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 lit citations: - 1. This Guarantee applies only to the specific sevier lines cleans1, or plumbing fixtures or plumbing parts supplied acid .installed by Roto -Rooter Servipe & Plumbing Co. - 2. Roto -Rooter Service & Plumbing Co. must receive notice of tier 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. .Materia)s furnished or work perfonned.. by other than Rata -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 tb;eiru of jests, including but not limited to sanitary articles, paper -tow cl s, toys, etc.-. or e._ Sewer linos which are settled, broken, offset deteriorated. dama-ed or improperly .or illegal iv installed. 2. Drains, ~ewer lines. plumbing fixtures on septic ystems. g: Commercial accoj,its. 4. Tfiy Guarantee Petiod. c aimieiices on the date or original sei -ice and shalt Piot be extended by subsequent seti-ices or repairs inaade pursua^it to Ow izrtnm of the Oui rantee. The Guarantee hereunder extends to the cus%, ner invoiced for the services Uid is not transferahle. 5: Roto-Rootzr Service (% ➢Fiinribing Co.'s liability hereunder shall be limited to rMeanio , of drain or cetivcr stoppage Ov ax. two repel visits) or the ,e; aiz t,. tepjacentent of defect`s glut' lining fixtures pluntbing parts: Roto -Rooter Scrv'icc & Pltnnl;ing CO. %hall not he liable for (1) Incidental or canscquettt: a; Jan .does; (2) 'Ahiler damage: (3) Loss of u,,o: or (4) Loss of anticipated benefits or profits. any of which result from tie furnishing M scar ices tri proi.ut €s, or (roar► lii%a broad: of the Guarantee, even if Roto -Rooter Service & Plumbing Co. kneel of the likelihood of ,ugh damages. tz, Ani. implied v arranty of inerchantability. or fitness for a particular purpose: of use. shall he limited to the duration of the foregoing written guarantee. The foregoing written guarantee is the customer's sole and exclusives remedy and in lieu of all] other guaranties. and warranties, express or .;mplied. or omil. This guarantee may only be modified in writing, signed hal an officer of Roto -Rooter Service & Plumbing Co. --7. his guarantee does not apply in the event custom r breaches any of tine Teilns and Conditions of service. including but notlinaited to timely payment of ^al charges. TT IS: INET 10 D:two k FINANCE CHARGE will he computed on the unpaid balance by ai sinulc period rate of 1-1/24P, piCr wontj', yhich is'an A .'NNll1AT, )<"laRC E iTAGIE,11 NTE OF 180 . "State: 1,nv retlui, 's any one who coi3tracts to `do constructi t,n work to E c ticensod i -w 6T Coritraciors Sion ' end Boar6 i -n, Elle k enSe categoz V In ix'.h1eh the co,ttr oris gping to be workinei - if the total price of the job is. 010 rn• wore Jnclu€?ing labor inn a Liceasoct conizraCtOr> are r_'gulaied by Tawas dcsio=xtto protect '.,k publ9-,. if YOU contract wv,h <u!nz-o,,' :63:J clots not li i, alic nsc. lie Contractors State t_oca,r e p;i:Pre. ,P;awInc uij ible to assist you rath a ^nPtipiain. WPir only rePnedy apariiist an ttrircinsc.d o=; saztor i,lay b;. in civil court: amid you may be la ` c :tri: i,Ci Lu of I0ii Jtf njurlCti CO fhe ei!ritBa,'tur K Cs11fFlQyeb:,. r i ru a ,a' co, aEia_e th Corat; ictors St.atc-I'J sense Beard io find out if this coni?actor has a valid lice=nse. Tho buaid !;as cotitplute itifotmation or'he history including ar,y possible suspoilsiotati. revocittiain,. jud>,e1,1111 11110 Lita3tianb. Tela board has offices throughout C iltCornk . Please i h o k Tie ; s ; ;, tieE_t pages of the shite prises litr the office nearest you or cai"1 (, .,Otl) 321-CSLB for tore information. " 1 m1 .jan »l a:1rr p9 g(( hft'_N0Kr 'O C C C=" Pt (Single) Family Owner 0=,,pied I . Basin, Tub, Shower, Kitchen Sink. Laund ,y and Sewer in, Good Coet;1 "ion with Clean Out ....g0 days 2: ,Sewer From Roof Vent (2J Roof Vent-GGuarantee) .....:............................... i0 days 5 3. Toilet Stoppage and Area Drain ........... ....... ......10 days 4. Single Family Rental (Single Unit Only) .... v .....: ................`................30 days 5' Ali Plumbing, Repairs and Replacements .............................. .I Year Parts & Labor CCS INIDMONS AND IEX(CILUSEMS Roto -Rooter Service & Plumbing Co. guarantees the,services performed as set forth in this invoice to be tree from defect in materials or workmanship for the applicable time p riod stated above. If wichin the Guarantee Period a drain stoppage or other defect in the repair of plumbing fixtures or plumbing Darts installed l y 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 lit citations: - 1. This Guarantee applies only to the specific sevier lines cleans1, or plumbing fixtures or plumbing parts supplied acid .installed by Roto -Rooter Servipe & Plumbing Co. - 2. Roto -Rooter Service & Plumbing Co. must receive notice of tier 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. .Materia)s furnished or work perfonned.. by other than Rata -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 tb;eiru of jests, including but not limited to sanitary articles, paper -tow cl s, toys, etc.-. or e._ Sewer linos which are settled, broken, offset deteriorated. dama-ed or improperly .or illegal iv installed. 2. Drains, ~ewer lines. plumbing fixtures on septic ystems. g: Commercial accoj,its. 4. Tfiy Guarantee Petiod. c aimieiices on the date or original sei -ice and shalt Piot be extended by subsequent seti-ices or repairs inaade pursua^it to Ow izrtnm of the Oui rantee. The Guarantee hereunder extends to the cus%, ner invoiced for the services Uid is not transferahle. 5: Roto-Rootzr Service (% ➢Fiinribing Co.'s liability hereunder shall be limited to rMeanio , of drain or cetivcr stoppage Ov ax. two repel visits) or the ,e; aiz t,. tepjacentent of defect`s glut' lining fixtures pluntbing parts: Roto -Rooter Scrv'icc & Pltnnl;ing CO. %hall not he liable for (1) Incidental or canscquettt: a; Jan .does; (2) 'Ahiler damage: (3) Loss of u,,o: or (4) Loss of anticipated benefits or profits. any of which result from tie furnishing M scar ices tri proi.ut €s, or (roar► lii%a broad: of the Guarantee, even if Roto -Rooter Service & Plumbing Co. kneel of the likelihood of ,ugh damages. tz, Ani. implied v arranty of inerchantability. or fitness for a particular purpose: of use. shall he limited to the duration of the foregoing written guarantee. The foregoing written guarantee is the customer's sole and exclusives remedy and in lieu of all] other guaranties. and warranties, express or .;mplied. or omil. This guarantee may only be modified in writing, signed hal an officer of Roto -Rooter Service & Plumbing Co. --7. his guarantee does not apply in the event custom r breaches any of tine Teilns and Conditions of service. including but notlinaited to timely payment of ^al charges. TT IS: INET 10 D:two k FINANCE CHARGE will he computed on the unpaid balance by ai sinulc period rate of 1-1/24P, piCr wontj', yhich is'an A .'NNll1AT, )<"laRC E iTAGIE,11 NTE OF 180 . "State: 1,nv retlui, 's any one who coi3tracts to `do constructi t,n work to E c ticensod i -w 6T Coritraciors Sion ' end Boar6 i -n, Elle k enSe categoz V In ix'.h1eh the co,ttr oris gping to be workinei - if the total price of the job is. 010 rn• wore Jnclu€?ing labor inn a Liceasoct conizraCtOr> are r_'gulaied by Tawas dcsio=xtto protect '.,k publ9-,. if YOU contract wv,h <u!nz-o,,' :63:J clots not li i, alic nsc. lie Contractors State t_oca,r e p;i:Pre. ,P;awInc uij ible to assist you rath a ^nPtipiain. WPir only rePnedy apariiist an ttrircinsc.d o=; saztor i,lay b;. in civil court: amid you may be la ` c :tri: i,Ci Lu of I0ii Jtf njurlCti CO fhe ei!ritBa,'tur K Cs11fFlQyeb:,. r i ru a ,a' co, aEia_e th Corat; ictors St.atc-I'J sense Beard io find out if this coni?actor has a valid lice=nse. Tho buaid !;as cotitplute itifotmation or'he history including ar,y possible suspoilsiotati. revocittiain,. jud>,e1,1111 11110 Lita3tianb. Tela board has offices throughout C iltCornk . Please i h o k Tie ; s ; ;, tieE_t pages of the shite prises litr the office nearest you or cai"1 (, .,Otl) 321-CSLB for tore information. " OWNER/,BUILDER ._INFORMATION -- — --- Dear — 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 property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. 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 various 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 including State and Federal income tax withholding, federal social 'security_ taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may. be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are 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 F(760) 777- 01 ,Z;1Zo-9-oz OWNER'S SIGNATURE/DATE 7 .2 Gt //em, I12 D L 3Qu4.vi6 PROPERTY ADDRESS 007/0 - 103 PERMIT NUMBER(s)