Loading...
0303-203 (PLBG)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 C36 C42 .F 611/3]121( ate., '_Signature of Contractor /--►.• /'�;rr a _ 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. ( )) 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 .3TA..TF Policy No. I693392.03 (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 C de, I shall rt with comply witK't'hose provlslors. ate: r� zy"e? Applicant �. / W.. 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 propertyfoVin_pection purposes. /Ignature (Owner/Agent), /`'a`+—'r`' ✓''�'!• Date "� j%� BUILDING PERMIT PERMIT" DATE VALUATION LOT TRACT JOB SITE APN ADDRESS 5-4- 590 AVL:NWA TZIUS1'0 OWNER CONTRACTOR/DESIGNER/EN INEER 30M 1 RA'i' kM AND ROTO 1`'C➢U9:1 ")R .54.580 AVENIDA RUBIO, 79614, STATE Vr. LAt7U7. ,7, A CA 92253 Mz . CA 92543 (909)6358-8541 CI3Z�i' 1061) USE OF PERMIT F SEPTIC ABANDONMENT AND S?,Vf VR LOOKUP VAULIATION %000.00 LZ ESEMA= C09C OF 0014 f'(BIXi"ECJH 3100019x3 PLUMBM0 FR -- 3E 1Y 'R 101.000-4I9.000 X30,00 BUIL-i" A[. +C01%1 '-RTJCT'IC)YdAMN PLAN CH $30,00 LESS .P 4S-1'AID 1 f41± $0.00 RECEIPT DATE BY DATE FINAL ED INSPECTOR �y 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 OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali 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 Y Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover - Sewer 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 Use of Power Finat Utility Notice (Perm) COMMENTS: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL No 97586 Date: L13, 9a 3 k a15 Toct S G G.A. Code �q91, v } Received From: Quo RQ ote-r Address: Account No. } ' 1 Lot(s) Service Address ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge' ❑ Sanitation Capacity Charge U,�J ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee -Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other L TOTAL Remarks: 00 L9'Eopy to: 1 &.E.- Cash Water Service Check (o l -7- Money Cashier Order CVWD-438 (11169) � % ❑ HEMET (909) 658.8541 ❑ BANNING (909) 922-9491 El LAKE ELSINORE (909) 674.2312 ❑ RANCHO/TEMECULA (909) 699.0555 ❑ FALLBROOK 8 BONSALL (760) 728.7497 ❑ OCEANSIDE, CARLSBAD (760) 722-3155 Plumbing Repair ............. ❑ BEAUMONT (909) 845.3338 ❑ REDLANDS/YUCAIPA (909) 797.8697 ❑ VISTA 8 TRI -CITIES AREA (760) 726-6260 LIhODTERa ❑ PERRIS (909) 657.9852 ❑ PALM SPRINGS/DHS (760) 322-2622 ❑ ENCINITAS 8 CARDIFF (760) 753-2674 ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346.1736 ❑ DEL MAR 8 SOLANA BEACH (1158) 481.1633 Plumbers Division of RotoCo., Inc. License Number 422155 • Federal ID Number: 33-0475032 G % %,3 1 ❑ YES GUARANTEE O NO 8 A.M.- 5 P.M. MON. THRU FRI. Main/Branch Lines ............ O 6 months Toilet Auger .................. ❑ 7 days Plumbing Repair ............. ❑ 6 months Plumbing Replacement ...... O 1 year Extended Guarantee ..... . ... ❑ 1 year ❑ WEST RANCHO BERNARDO 8 WORK ORDER NO. WEST RANCHO PENASOUITOS (858) 4842138 u ❑ LAKE SAN MARCOS 8 LA COSTA (760) 726.6720 7 ❑ RANCHO SANTA FE 8 OLIVEHAIN (Q858) 756.3396 Q DATE...C�..:.�.4 7JOB # ..............I.....-.1.................................. 796 N. STATE STREET • HEMET, CA 92543 Toll Free: (800) 491-7686 • Fax: (909) 652-9515 • 1-600 GET ROTO (436-7686) TECH # 1 pSe ... FIXTURE MAIN LINE: FT O ' BATH SINK - - - - - - - -0 PURCHASE ORDER CLEANED: TOILET - - - - - - - - - - -0 KITCHEN SINK - - - - -0 BATHTUB ---------0 LAUNDRY ---------0 _ SHOWER ---------0 URINAL -----------0 STATE ZIP =ACCESSEDA CAUSE OF STOPPAGE CLEAN OUT O ROOTS O GREASE ❑OTHER ❑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, or clean outs and any damage resulting from cleaning or repairing such lines. I have asked Roto -Roofer 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 props r detailed oath s Invoice; and 3) 1 expressly acknowledge and waive the right to cancel this cant rac 1jii "three or seven busing days, whiCfi er applies. _ (PRINT NAME) l _a fi + I . !>!�� _(SIGNATURE) a COMPLETION i knowledge completion of the above described work which has been done to my complete satisfaction. Toilet Auger .................. Plumbing Repair ............. PLEASE INITIAL FOLLOWING: A. The serviceman discussed Roto -Rooter products with me. 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. z CLEAN UP EXCELLENT ❑ SATISFACTORY IO POOR CUSTOMER COPY TECH#2 .............................................. FLOOR DRAIN - - - - -0 FLOOR SINK -------0 AREA DRAIN -------0 OTHER O TIME OUT DRAIN CLEANING ADD -L FOOTAGE ADD'L FIXTURES PLUMBING LABOR f PRODUCTS/TREATMENT VIDEO INSPECTION HYDRO-JETTER MINI JETTER LINE/ LEAK LOCATION PUMP SEPTIC/GREASE OTHER 0 TAX TOTAL li PAYMENT RECEIVED 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 SEE REVERSE FOR TERMS & CONDITIONS O CASH O BILL O CK # O CREDIT CARD/TYPE 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 &dumbing 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 f 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. b. Any implied warranty of merchantability, or fitness for a particular purpose of use, shall`K11imited 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 miplied, written or oral. This guarantee may only be modified in writing, signed by an officer of Roto,--Rooter-Servide & Phmrbing,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) are entitled 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 labofand 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-CSLB for more information."