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04-3513 (PLBG)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Nu �er: U Applicant: // _ -.4- Applicant's Mailing Address: C&t�l 4 4 V BUILDING & SAFETY DEPARTMENT M 5!19r�Z7 Architect or Engineer: VOICE (760) 777-7012- FAX 77-701TFAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S 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 Codarhd my License Is in full foroe and effect.��� _ License No. �S 0 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License low for the following reason (Sec. 7031.5, Business and Professions Code: Any city or statement county het T she tioe s mitsed to construct, altar, improve. demolish. or repair any sbucture, prior to Its issuance, also requires the applicant for the permit to file a signed pursuant to ft provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).): U 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 (Sea 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the trrhprovements 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 or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.3 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to sell -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 and -policy number are: �Eartier S/%%e /`LO.v/J icy Number /Z_� _ I certify that, In the performance of the work for which this permit is iss ed, 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 Chose provisions. 6DV 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. . CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of Le ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this perhiL 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 county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enteruponthe above-mentioned property for inspection purposes. (Applicant or Agent): Aopo J ❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 ❑ FALLBROOK & BONSALL (760) 728.7497 ROTO_ ❑ BANNING (909) 922-9491 ❑ RANCHO/rEMECULA (909) 699.0555 ❑ OCEANSIDE, CARLSBAD (760) 722-3155 ❑ BEAUMONT (909) 845.3338 ❑ REDLANDSIYUCAIPA (909) 797-8697 ❑ VISTA & TRI -CITIES AREA (760) 726.6260 L8000TER. ❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322-2622 ❑ ENCINITAS & CARDIFF (760) 753.2674 ❑ SUN CITY (909) 679.8919 ❑ INDIO/PALM DESERT (760) 346-1736 ❑ DEL MAR & SOLANA BEACH (858) 481.1633 Plumbers Division of RotoCo., Inc. License Number 422155 - Federal ID Number: 33-0475032 ❑ YES GUARANTEE ❑ NO 9 A.M. - 5 P.M. MON. THRU FRI. ❑ WEST RANCHO BERNARDO & WORK ORDER+40. WEST RANCHO PENASOUITOS (858) 4842138 • LAKE SAN 20 ❑ RANCHO SANTO A FE & OLIVEHA N (858)7 56-3396 273559 796 N. STATE STREET - HEMET, CA 92543 Toll Free: (800) 491-7686 - Fax: (909) 652-9515 • 14800 GET ROTO (438-7686) FIXTURE MAIN LINE: CLEANED: TOILET - - DATE......`w�a.Y JOB # .................1.4e............................. TECH #1 .......... `.�.,.. TECH #2 .............................................. FT BATH SINK --------0 FLOOR DRAIN -----0 SHOWER ---------0 URINAL -----------0 'ACCESSED VIA CAUSE OF STOPPAGE - DRAIN CLEAN OUT 0 ROOTS ❑ GREASE VENT QOTHER (]UNKNOWN TIME IN _ ESTIMATE: My estimate for performing this work is: $ WORK ORDER AUTHORIZATION / WAVIER: I authorize Roto -Rooter to perform the described services and I agree to pay the amounts Indicated. I understand that Roto -Rooter is not responsible for broken, settled, rusted, deteriorated, or lead pipes, fixtures, of 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 seven business days, whichever applies. (PRINT NAME) (SIGNATURE) COMPLETION i acknowledge completion of the above described work which has been done to my complete satisfaction. PLEASE INITIAL FOLLOWING: / A. The serviceman discussed Roto -Rooter products with me. I I 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. CC aEXRDATE 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 C CLEAN UP ❑EXCELLENT ❑SATISFACTORY ❑OR POSEE REVERSE FOR -TERMS & CONDITIONS' CASH ❑BILL ❑CK# CUSTOMER COPY ' ❑ CREDIT CARD/TYPE CONDI'T'IONS 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 result should 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) areentitled 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 be computed on the unpaid balance by a single period rate of 1-1/2% per month, which is an ANNUAL PERCENTAGE RATE OF 18%. "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. 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-CSLBloi more information."