9703-093 (PLBG)I—
W. r;
N Lu..t
O Z) ('
r 0 Lo
r r
C
Z n
�Or�
c0 F_ O
W LU cfl
F- tl
U)
Z
co
LO
N
ON
U °'
CLa
It 2 Z
Lo a 0
0 J J
co Q U
OU
LO
Z
r, Cil
Q
J
LICENSED CONTRACTOR DECLARATION
4 hereby affirm under penalty of perjury that I am licensed under provisions of
%hapter 9 (commencing with Section 7000) of Division 3 of the Business and
1'Prolessionals Code, and my License is in full force and effect.
License # ;X y� f�. Lic. Class Exp. Date
If q
bii� d J!
/ate rSignature of Contractor�� •''�-� -t
i
OWNER -BUILDER
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone 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 thoseprovisions:. /
Date: � ' '%' C�Applicant� fn r�4 .�.
!
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, & shaliF;•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 ilios'pection�puurrposs9es
4i nature (Owner/A ent) `�✓t�Irz� {:Cate
. PERMITk CONTROL#
BUILDING PERMIT4855
5
u��
974.13-0934 8 5
DATE VALUATION LOT TRACT
3124197
JOB SITE
ADDRESS 7"09 V I(E STA
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CLIFF "!"C7fl`'Et+I
12C71't_?-1tC3t71'CK
79-900 FIESTA,
796 N. STATE S'1'
LA � UIV.C,A CA 92253
HFN11.7 CA. 92 543
t
(009)658-8541 �131.1e .
USE OF PERMIT
PLUMB
36WEIR CONN] Y. -Ti sap -1'1C A13/iN60NNTNT
1,500.00 LS
US aIIAIA'. ED CWT OF COP`+'STC►US':`1110N
i°y1.VMl3Ir40 FRE. — SEWLTR 101 -OW -419-M
a '
j. C'0N9J'R (,fC T10N 14ND P1:, x.`1'4 O'HECK
AIr0rf
LESS . PRE -PAID .R. S
3 A.iiii ...
MAR 41997 TO AI. PERIWIT FEES DILTE NOW
530.00
A
u 4
FttCEtPT
DATE
BY
DATE FINALED
INSPECTOR
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
Waste 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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring `
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
10
-.8001111111111
00 AMUR
NGE
935 ��
01O
tw
Remit to: 788 NO. STATE STREET • HEMET, CA 92543
er 10,00Plumill
❑ HEMET (909) 658-8541
❑ 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
❑ INDIO/PALM DESERT (619) 346.1736
❑ TOLL FREE: (800) 491-7686
❑ FAX: (909) 652.9515
JOB NAME
DATE: �J
JOB LOCATION
P.O. NUMB
CITY
STATE ZIP
PERSON CALLING:
Q t r,/V'F-ce
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 Relp ❑
REMARKS:�.!/i?sKi
PARTS:
PRODUCT:—
TAX:
RODUCT:_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 from a roof vent is improper access and can only 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 has a zero guarantee /.
114444 CUSTOMER SIGNATURE OPERATOR SIGNATURE
CUSTOMER COPY /
Division of Roto Co., Inc. • License Numbers: 334418, 422155 • Federal ID Number: 33-0475032
O
Jefferson Street Lift Station
Forcemain & Gravity Sewer
Reimbursement Agreement
Name
Lester C. Cox, Jr.
Countrywide Home Loans
Stewart Title of the
Inland Empire
Address
79-795 Fiesta Drive
79 -880 -Fiesta Drive.
79-920 Fiesta Drive
Amount Ci tz ra
$ 2,100.00 7/15-/-�7
2,100.00 y/4I q0
2, 100.00
$ 8,400.00
JuIwZ5-1�8 11 W From -WATER DISTRICT/COACHELLA VALLEY +T603982711
COACHELLA VAL Y WATFR DISTRICT
_ J7 CASH aE --I PT DETAIL
Received From: _1 11 wo a 0772FN /F N\ 4 lj_
-.
Account No.-
Zorvico .Adlfass
Bachilow(s).
cruse Laterai(a)
0 Dot ootorChao k,$)�_ _
( Metar$urchargs
anitatlanCapaclryCnarge s - -
W.S.S-F,C.
7 Temporary Construetlon Meter
0 Turn on Charpm
❑ Unnollocted AccOUnt- Name
Q InspectlanFee-Ttact-
Fee-
G Plan Chock Fees; Water ! Sewer -
Tract -
❑ Bond Payment - A-D. - Bond.._._.
❑ Gustomeresposlt,�_
f"I f-SehF:r
134oPy to:
Gash
Check.}
Money
order
Lofts)
T-662 P.05 Fw68Z
G.A. Code
- 1
1
Water Service ^.11
trCYWA-age I11168)
C
RoGeived G7-25-2008 11:49am From-+7803983Ti1
Tc-CVWD PD SATELLITE Palle 005.