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9804-180 (PLBG)U) N U) W E)::) M_ d 6Zr� ZoOo LU LU a - N Z M Ln N O� U a_ Q — Ir Lo Q 0 W X W — mVU O. Q d rn FC 0) Z_ r Z) O Q J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I_ am licensed under provisions of Chapter 9 (commencing 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 01B 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: (X\) 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). () 1 -dm exempt under Section , B&P.C. for this reason,. t,,Date f 1-) <_.' Signature of Owner WORKER'S COMPENSATION DECLARATIONv ` 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: CarrierAAS I ty; Nq 0 5 & 415 1 (?o (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', (•shall forthwith comply with)those provisions. h�' Da ,te: ; Applicants 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. r I i VSignature (Owner/Agent) ' /tt?_ C / ..3 /.i.iDate •% 4- r: 1t BUILDING PERMIT PERMIT` °°NTR°`#NO DATE 4f'0"S VALUATION � LOT TRACT/ �,01 c- f �. C JOB •� ADDRESS •l7-495 CAI��. E �'�I.�a1 ,GO APN 'l �..A�.��ar�a- . OWNER CONTRACTOR/DESIGNER/ENGINEER Y`3?I.14 A. S"PRN. GER 0NkINE. ft f fl, UII D4sk PO BOX 161 LA QWN'!A C.A. 92253 COLA fl USE OF PERMIT PLUMS ..T IC Ab ON. SEWER C1M*q.:CT PAID' VALW8...TION 1,500.00 L3 .SIT ®F Lia aun,,-r. SVIEB•t3r.XIIED COST t l l r3n�f 3Nr l+EE _a :il3Wlr"!2 iol-0001.439-€00 S30.W) v� 1 . - •W Srs»1-r('17`Ab CON'S UC..'TTCAN MWI) FLAN CH_ F K $30A LESS MIE-PAIDPEES $0.00 TOTAJ- PERAUTFEES OUR, NOW $30.00 t `; RECEIPT 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 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 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 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F j. Sm &,e Detectors Temp. Use of Power L FIPYall Utility Notic�. (Perm) Final COMMENTS: 773 —60/3 OWNER/BUILDER INFORMATION 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 State 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 FAX (760) 777-7011 OWNER'S SIGNATIIJRE/DA c � i 7 1�_ A�4e6-e:,,^ 04� PROPERTY ADDRESS .�1c✓fie/. - I�i Q j� 04 PWAY Gp TROUBLES .DOWN Slew 9 �N WORK ORDER NO. 12 v 9 9 4 DTER® LUMBERS ❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 ❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555 II Free: (800) 491-7686 ❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 ` Fax: (909) 652-9515 ❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DESERT HOT SPRINGS (760) 322-2622 i • HEMET, CA 92543 ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346-1736 LINE ----------- ❑ BATH SINK ---------- ❑ FLOOR DRAIN -----❑ . SJATE ZIP RDER NO. ` LINE ----------- ❑ BATH SINK ---------- ❑ FLOOR DRAIN -----❑ . T ---------------❑ KITCHEN SINK ----- ❑ FLOOR SINK -------- ❑ -----------❑ LAUNDRY ------------ ❑ AREA DRAIN -------❑ NB - -------- ❑ URINAL --------------- ❑ OTHER DESCRIPTION PRICE PRICE DRAIN CLEANING ( FT.) ADDITIONAL FOOTAGE ( FT.) _ADDITIONAL FIXTURES(S) TRAP / TOILET REMOVAL LABOR VIDEO INSPECTION MINI JET HYDRO-JETTER LINE / LEAK LOCATION PUMPING GREASE / SEPTIC CHEMICAL TREAT CHEMICAL OTHER 1 SUB TOTAL JIIP REQUIRED ❑ YES ❑ NO :COMMENDED ❑ YES ❑ NO i�f4 lk- DATE JOB # SERVICEMAN 1 SERVICEMAN 2 DAY GUARANTEE (SEE BACK PAGE) ACCESSED VIA: CAUSE OF STOPPAGE: TIME: DRAIN ----------------- ❑ ROOTS --------------❑ IN CLEAN OUT -------- C:1 GREASE ------------❑ OUT VENT ------------------❑ OTHER DESCRIPTION PRICE DRAIN CLEANING ( FT.) ADDITIONAL FOOTAGE ( FT.) _ADDITIONAL FIXTURES(S) TRAP / TOILET REMOVAL LABOR VIDEO INSPECTION MINI JET HYDRO-JETTER LINE / LEAK LOCATION PUMPING GREASE / SEPTIC CHEMICAL TREAT CHEMICAL OTHER f PARTS TOTAL TAX TOTALJW, -(2-U ❑ CREDITCARD ❑ CASH ❑ CHARGE ❑ CHECK#�i3 g CC #: EXP DATE: AUTH. # Fcussed Roto -Rooter products with me. sed additional lines cleaned at this time are half priced. vised that running my main line from a roof vent is improper access and can only be given a 10 day guarantee. a 90 day guarantee a clean out must be installed. A two inch main line roof vent has a zero guarantee. �� Division of RotoCo., Inc. License Number: 422155 • Federal ID Number: 33-0475032 STOMER SIGNATURE ALL SALES FINAL CUSTOMER COPY CONDITIONAL GUARANTEE This is a Sinding 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 (up to the original time charged.for) at no charge - maximum 2 (two) repeat visits or refund me at our discretion. Main line stoppages are guaranteed against roots only, and must have 3" o access. All other lines are guaranteed against normal build-up only. Stoppages caused by a sept 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. TERMS: NET 10 DAYS. A FINANCE CHARGE will be computed on the unpaid balance by a single period rate of 1-1/2% per month,.which..is an, ANNUAL PERCENTAGE REATE OF 18%. "Under the Mechanics' Lien Law (California Code of Civil Procedure, Section 1181 et seq.), any contractor, sub -contractor, laborer, supplier or other person who helps to improve your property but Is not paid for his 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 own contractor In full, if the subcontractor, laborer, or supplier remains unpaid." 7- COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL i7824 Received From: - - - - - - - - 9y 17� , Address: Account No. s) Tract Service Address G.A. Code 0 Meter(s) $ 0 Service(s) 0 Backtiow(s) 0 House Lateral(s) 0 Detector Check(s) 0 Meter Surcharge Z 11 Sanitation Capacity Charge 0 W.S.B.F.C. 0 Temporary Construction Meter 0 Turn on Charge 11 Uncollected Account Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water Sewer - Tract - 0 Bond Payment - A.D. --Bond Assmt. 0 Customer Deposit 0 Other TOTAL $ Remarks: C t-4- xCopy to: Cash Water Service Check Money Cashier 4� Order CvVV D-438 (11189) a