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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
C36 C42 B A 01/31 ?.f
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:
( ) 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). ,
O 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 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 S-T.%TR -KIND Policy No. 1683392-'03
(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 Provis,ions.
Date"%�j Applicant j¢"%
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.
Signature (Owner/Agert))-��'f.�"' Z-5_.tet. Date /1'VY'�
BUILDING PERMIT PERMIT#
031. 1-1311
DATE1147 Ji1JATION $31M.11.00 :LOT. TRACT
ADDRESS 5J,_96 jVa. .off. AIj��Jj�,.ECe JOB SITE APN
OWNER CONTRACTOR / DESIGNER / EN INEER
DAMOMMMT RUM ROOTER.
51-96Q AM41DA.1v`Ag1ATs RO 796 N. VIATE ST.
LA QUDrl'IA. CA 922.3 ]UNW.' ,'CA x'2543
(909>658-8541 CB '1060 y -;
USE OF PERMIT
'PLUMBING
VALLIATIOW 3,n00.A0 I41-
E497.gu7: w C'(3sT or C01Q1.nRVM'.f0X
101-000-419-000
D NO�V 17 2003
CITY OF LA. Q5INTA
.: FINANCE DEPT.
8XIB.-'1OTAL L C?�WRTJC!Tlq�r AND P1.+,fiAf' (MCK.
LESS PRE -PAID FIX49
TOTAL 1:°1 RAW72-0'1 F.S 17VENOW
RECEIPT DATE`• � � •' `f} I8Y' 1,.1Li �DA�pIQL� /,�',:,�.'I'INSPE R
�A) D,M
$30.00
$0.00
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 8 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
5'ewer 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:
1
i
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: Affo.)%. i X Vv - la V",\
Address:
Lk V_
, Y
Account No. Lot(s)
�
Service Address
0 Mater(s)
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Me rsurcharge
litation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account -Name
0 Inspection Fee -Tract-
Fee -
0 Plan Chebk Fees Water I Sewer -
Tract -
0 Bond Payment - A.D. - Bond
Assmt.
0 Customer Deposit
0 Other
TOTAL
Remarks.
W&PY to:
\41
cash
Check WaterServi Ct
Money
Order Cashier
CVD -438 (11189)
:DIvIsIon
OTER®
Plumbers
of RotoCo., Inc.
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COURTESY INSPECTION OY NO
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❑ HEMET (91349) 658-85141
❑ LAKE ELSINORE (909) 674-2312
❑ BANNING (909) 922-9491 .
❑ RANCHO/TEMECULA (909) 699-0555
❑ BEAUMONT (909) 845-3338
❑ REDLANDS/YUCAIPA (909) 797-8697
❑ PERRIS (909) 657-9852
❑ PALM SPRINGS/DHS (760) 322-2622
❑ SUN CITY (909) 679-8919
❑ INDIO/PALM DESERT (760) 346-1736
796 N STATE
ST • HEMET CA 92543
WORK ORDER NO. 251151
DATE �/�%�� JOB # 2
Toll Free: (800) 491-7686 Fax: (909) 652-9515 TECH #1� / TECH #2
1-800 GET ROTO (438-7686)
X475032 FIXTURE MAIN LINE: FT ❑ BATH SINK - - - - - - ,- -❑ FLOOR DRAIN - - - - -❑
PURCHASE ORDER #
CLEANED: TOILET - - - - - - - - -❑ KITCHEN SINK - - - - -❑ FLOOR SINK - - - - -❑
BATHTUB ---------❑ LAUNDRY --------- 11 AREA DRAIN -------❑
SHOWER --------- 11 URINAL ---_-------- ❑ OTHER ❑
STATE ZIP o YES GUARANTEE El NO
8 A.M. - 5 P.M. MON. THRU FRI. TIME IN TIME OUT
ACCESSED VIA
❑ DRAIN ❑`CLEAN OUT
❑ VFNT '
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 priced
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 90 day guarantee a cleanout must be installed.
❑ CASH ❑ BILL ❑ CK # ❑ CREDIT CARD/TYPE
CC EXRDATE 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.
WAIVER OF RIGHT TO CANCEL: \COrdhOldef $IgnatUre x
Pursuant to Section 1689.13 of the Colifornia Civil Code. I acknowledge and hereby waive my right to cancel the sale within three days and ocknowledge
that the products and services rendered hereunder are emergency repairs.
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF L
CUSTOMER COPY
Signature
Acknowledgement Completion
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(Single) Family Owner Occupied
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S1.
Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days01
5
5
5
2. Sewer From Roof Vent (2' Roof Vent$ Guarantee)..................................10 days
3. Toilet Stoppage and Area Drain.................................................10 days
4. Single Family Rental (Single Unit Only)...........................................30 days
5
55.
All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor
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CONDITIONS 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 0 ) 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.
TERMS: NET 10 DAYS. A FINANCE CHARGE will be computed on the unpaid balance by a single period rate of 1-1l2% 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 complain. 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) 3121-CSLB for more information"