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0206-040 (PLBG)H N_ U) W O =) co d r- W oZ COD O Uc- L Si Z C0 Lr) N ON U °) Q ir r � 0 W 0 JJ m<Q li rnH �t Z_ O 5 I- C) 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 422155 C-36 x`42 91111 0413()12( Date% Signature of Contractor NIA, 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). ( ) 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. (�F) 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: Carver tIXf FUND Policy No. MV39241111 (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 provisions. Date: Applicant -(�� ,,,..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/Agent) Om Z„f� Date PERMIT#J BUILDING PERMIT 4 9) �tf VALUATION LOT TRACT DATE arv JOB SITE ADDRESS 52-875 AV UA G.14�'x�RMIZ . APN OWNER CONTRACTOR/DESIGNER/EN (NEER MNNi�ppR..�tA ,t�,(2.ZAGA *RaM R()(YIT,, c�. 52415 MWIDA"1 CARM;Z A 79614. aSTM CA 912;53 )RIFt -37 CA 92.14'_ (909)65818541 C:iRII 1060 USE OF PERMIT ��r/'� P1 iy1.�7s )itlL7 wHSF k�'.t'IC ada.i;3.AN3�UAfy .��:;n" I:L70K'•t;�' VA9LLfATI(M 2xhA�.is 3 4+�1�i9. 01? L.1.T�.�iSA,.SA4€ir, ON .IY�J'lN'.{V PIUM11' y9 yg^��gg�� {yMg6�78.TiS1�d.69'A�V A-d:+d�\.4Y'iEl' A1. �RJA�:Ad51. ARJ. PLUM MING FEE _ SEWER 101-0004)9-000 •�;��.p4 a . - c x r .r �r r�c� rt�t D P. V3 PRE-TIAID Asti $30.00 0 Sri, W JUN 0 F [UUZ '�: LrNRIWI�'WRN�����:.�(���r CRYOFLAQUINTA -- FINANCEDEPT. RECEIPT DATE BY DATE FINALED INSPECTOR (n''� C• (J� •� 1��� - �^ INSPECTION RECORD OPERATION I DATE I INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wa1I Firewall Exterior Lath Drywall - Int. Lath OPERATION I DATE I INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final Final f 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 _ _ PLUMBING ste Lines Gas Piping APPROVALS Gas Test Electric Final Heater Final L er Piping Plumbing Final Plumbing Top Out i Equipment Enclosure Shower Pans _ O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service i Sub Panels Exterior Receptacles G. Smoke Detectors Temm p. Use of Power Final Utility Notice COACH ELLA VALLEY WATT M 01STAIICT OA3H R1O9111111 DB1AtL vitg "9 0741 : oz -,' Received From; r ryDate Address, '" Account No.bo - (s) • ( IR 1{ Service Address1Q�'hn9..M% ❑ Meter(s) - o,servic®(s) - ❑ Backflow(s) } 0 House Lateral(o) O Deteotor Cheok(s) Cl Met Surcharge anitation Capacity Charge 4 W.S,B,F;C. ❑ Temporary Con structl on Motor ❑ Turn9m0harge O Uncollected Account- Noma ❑ inspection Fee - Tract - Fee - ❑ Plan Check Fees Water 1 Sewer - Tract ❑ Bond Payment - A.D. - Bond AIasmt.. ❑ Custome.r0eposit ❑ Other Remarks; I � TOTAL C3 COPY to: Water Servloe Cash �, . Check V� Money ,u Cashier Order 1, Qt. ICVWD 438 (N1189) n Z00411 C3 COPY to: Water Servloe Cash �, . Check V� Money ,u Cashier Order 1, Qt. ICVWD 438 (N1189) n .- ROTOM Plumbers of RotoCo., Inc. License Number: 422155 • Federal ID Number: JOB ❑ HEMET (909) 658-854.1 ❑ 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 Toll Free: (800) 491-7686 Fax: (909) 652-9515 1-800 GET ROTO (438-7686) WORK ORDER NO. 209417 09 DATE,' JOB # TECH #1 TECH #2 )475032 FIXTURE MAIN LINE: FT ❑ ' BATH SINK - - - - - - - -❑ PURCHASE ORDER # CLEANED: TOILET- - - - - - - - - - -❑ KITCHEN SINK - - - - -❑ BATHTUB ------- -❑ LAUNDRY ---------0 SHOWER --------- 11 URINAL -•----------❑ STATE ZIP ❑ YES GUARANTEE 1:11 NO 8 A.M. - 5 P.M. MON. THRU FRI. TIME IN FLOOR DRAIN - - - - -0 FLOOR SINK -------❑ ,AREA DRAIN - - - - - - -❑ OTHER ❑ TIME OUT OURTESY INSPECTION (:EACCESSED VIA CAUSE OF STOPPAGE ❑ CLEAN OUT 0: ROOTS �' GREASE[xC El OTHER E]'UNKNOWN FIXTURE OK SERV $ AUTH. QTY. PART NO. — DESCRIPTION / REMARKS/ REPAIRS NEEDED PRICE MAIN LINE TOILET ❑���� BATH TUB ❑���� ��IC�%`eC/--tPf- t_ _ _ __ SHOWER ❑❑��� �� —�� BATH SINK �❑��� -���'"'r~ � _ • _ KITCHEN SINK LILC �JL�g; ,,...� DISPOSAL ❑��C �� y °r DRAIN CLEANING ADD'L FOOTAGE ADD'L FIXTURES �2 C� PLUMBING LABOR IL PARTS PRODUCTS/TREATMENT L` VIDEO INSPECTION J� HYDRO-JETTER • ' l MINI JETTER LINE/ LEAK LOCATION �� LAUNDRY. ❑❑�C ii ` l�f _ _f/��"` ' G--Fj��-' ' *jt PUMP SEPTIC/GREASEi�_ URINAL ��j(� OTHER FLOOR DRAIN❑�� FLOOR SINK❑�� ��� �_� �% __. _ —= — _ _—� — —�� —� -- �l _ TAX TOTAL PAYMENT RECEIVED . �1 AREA DRAIN7,7L___ =[ WATER HEATER C/O REQ. �r • . , 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. WAIVER OF RIGHT TO CANCEL: ❑ 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. Cardholder Signature X Pursuant to Section 1689.13 of the California Civil Code. 1 acknowledge and hereby waive my right to cancel the sale within on -y. u..0 ecru ,�w,auyc that the products and services rendered hereunder are emergency repairs. ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF FILE COPY Signature Acknowledgement Completion re rrr3j—E3 �.rt.r-�n�nU, L: I�n�r�t_n��rrr�r�rs��r�t 5 5 culesib,lentz,al Ouarantiee (Single) Family Owner Occupied _. 5 5 5 1. .Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out .'...90 days 5 5 5 S4. 2. Sewer From Roof Vent (2" Roof Vent$ Guarantee)..................................10 days 3. Toilet Stoppage and Area Drain ............................................. ...10 days Single Family Rental (Single Unit Only)...........................................30 days 5 Ccj 5 . 5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor 5 51 t��i�rJ�rJ�tJ�rJ�tJ�rJ�r__I"t PrJ�rJ�rJ��rJ�i 1�r__(rJ�rJ�iJ�t:Prat=Pr.P�fr�rJ�r�rJ�t1�rJ�rJ�rJ�r�rJ�r�c far: fr�rJ�t:t�tJ�rPtPrJ�rJ�r�cJr�r�rJ�rJ�rJ�r t�PrJ�r�cP CONDITIONS AND EXCLUSIONS Roto -.Rooter Service & Plumbing Co. guarantees the services performed as set forth in this invoice to be free from defz!et 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 set vice and shall not be extended by subsequent set vices 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. S. 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. TEMIS: 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). C/1 Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license. The Contractors rState 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) 321-CSLB for more information."