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15253 (PLBG)T -i -ht . 1 Building " 45--555 Cameo Palms Address i P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 _...._. Vossler Mailing Address -Sable City Zip Tel. Contractor tot© Roloter City Hemet, CA State Lic. & Classif. _ Arch., Engr., Designer Address - 92543 C36 334418 (909) 658--8541 City Lic. # 106.0 City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code, and my license is in full force and effect �.r..�'-�'"''.. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,eustness 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 for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec_ B. & P.C. for this reason Date Owner I WORKERS' COMPENSATION DECLARATION I herebyyaf lflf rm that 1 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.) Policyy Company &Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed N the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: N, 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 3708 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. I 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 No. 15253 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description .Sewer -Connect Project Description Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $2000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing • S.M.I. • Grading Driveway Enc. Infrastructure TOTAL • REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Cte e Rear Setback from Be Op'Ire Side Street Setbaa m Center ine Side Setba�� Property etc FINAL DATE \'`INSPECTOR C% Issued by. Dat\ �erm it Validated by: �„ 9� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEESs 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER RS. �T POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SO. FT. ® OTHER APP.IEOUIP. DRAINAGE PIPING WALL SO. FT. ® TEMP. POLE DRINKING FOUNTAIN SO. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM 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 REMARKS: LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3Ac HOUSE SEWER MESH 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 SEWER RS. �T ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR.. �/��y/ �� FINAL INSP. FRAMING FINAL INSP. 9S 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 COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received ( From:�7 i t (�, t' -.�^ Address: 7 9L �• S. //i%t Account No. 47" �! 10 -, off/-: Lolls) Service Address Lk, ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) �❑/ Meter Surcharge HI Sanitation Capacity Charge 5S ❑` W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt ❑ Customer Deposit ❑ Otper Remarks: ❑Copy to: Check Money Order G.A. Code N S TOTAL $ Water Be 11666 1 /"I i " t Cj- CVWD-0.78 (11189) SINCEPLUMBING 1935 SERVICE 40VV Remit to: 796 NO. STATE STREET • HEMET, CA 92543 ber 1,00! our Plum ❑ HEMET (909) 658-8541 El BANNING (909) 922-9491 ❑ BEAUMONT (909) 845-3338 ❑ PERRIS (909) 657.9852 ❑ SUN CITY (909) 679-8919 ❑. LAKE ELSINORE (909) 674-2312 ❑- RANCHO/TEMECULA (909) 699.0555 ❑ REDLANDS/YUCAIPA (909) 797-8697 ❑ PALM SPRINGS DESERT HOT SPRINGS (619) 322-2622 WIN-1 DIO/PALM DESERT (619) 346-1736 TOLL FREE: (800) 491.7686 ❑ FAX: (909) 652-9515 JOB NAME / / I DATE: ( — ( ^ JOB LOCATION P.O. NUMBER: 4 S`SS �� •^ fs CITY STATE ZIP PERSON CALLING: Length of Line .ft.. Hydrojet ❑ Washer Line ❑ Toilet ❑ Cable Size Camera ❑ Bath Tub Line ❑ Floor Sump Line ❑. Diameter of Pipe inches Main Line ❑ Shower Drain Line ❑ Urinal Line ❑ Pump Septic/Grease Trap Kitchen Sink Line ❑ Basin Line ❑ - Plumbing Repair ❑ REMARKS: e sz-r -00 4 d Q te PARTS: PRODUCT: TAX: SUB TOTAL: ❑ Credit Card ❑ Cash ❑ Check Number SUB TOTAL: LINE CHARGE: OTHER: TOTAL: $ ❑ Charge Account Number CONDITIONAL GUARANTEE This Is a Binding Contract — PLEASE READ CAREFULLY (GUARANTEE GOOD 8 A.M. TO 5 P.M. ONLY) For days from the above date, we agree to re -clean the above described line (up to the original time charged for) at no charge— maximum 2 (two) repeat visits or refund money at our discretion. Main line stoppages are guaranteed against roots only, and must have 3" or 4" access. All other lines are guaranteed against normal build-up only. Stoppages caused by a septic system, food scraps, rags, cement, other debris or broken settled sections of pipe are not guaranteed. ROTO -ROOTER is not responsible for any damages caused by backups, faulty plumbing or machinery. Customer is responsible for removal of lodged cables due to separated or root -bound lines. Customer is also responsible for any collection or attorney fees in regard to this invoice. PLEASE INITIAL THE FOLLOWING: A. The serviceman discussed Roto -Rooter products with me. B. I have been advised additional lines cleaned at this time are half price. C. I have been advised that running my mainline froma roof vent is improper access and caponly be given a 10 day guarantee. In order to get a 90 day guarantee a clean out must be installed. A two inch main line roof vent Lias a zero guarantee. 90845 CUSTOMER SIGNATURE CUSTOMER COPY "'z&OPERATOR SIGNATURE Division of Roto Co., Inc. • License Numbers: 334418, 422155 • Federal ID Number: 33-0475032