Loading...
0206-047 (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 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: lv 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 L " �► . Signature of Owner - ;' �" : v7 '�•' 7 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: Cartier Policy No. (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 tris 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. L . Signature (Owner/Agent) ' =: -- ' f4.4 < Date ..... PERMIT # ING PERMIT:. DATE LOT { TRACT 061/itg R9 �! JOB SITE ADDRESS 5.440 6�.�%EWDA R Z, E APN _ OWNER CONTRACTOR /DESIGNER / EN INFER At,S"00 DE L ARA OV11 uEK - BURDEk 54.440 AVIW iA RAb9LREL LA QUNTA CA 92253 - Mui` USE OF PERMIT p'i.L1R�i3�AFt:� SEPTIC A BAI+f D014; aL'A EYZ HOOK • UP VALUA31014 Sf .001.3 FLUMBI O IEE -• Wwm 103-000-419-000 r.• • k. "sE IB-`3.'d3`I'.AL. C®MMA,TiC[` ON WD .LAN CRECK $30.00 P.Elwllf I TOM DUE NOW JUN Q 6 2M CRYORAQUINTA RINCEOEK �-BY FIECEIPT DATE DATE FINALED INSPECTOR ,l;_.,,, INSPECTION RECORD ` OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS. BLOCKWALL APPROVALS - steel Set Backs Electric Bond ' Footings Main Drain Bond Beam Approval to Cover ti Equipment Location Underground Electric ^Final Underground Plbg. Test Gas Piping - PLUMBING APPROVALS' Gas Test Electric Final ., Waste Lines Heater Final € Vater Piping Plumbing Final «4 Plumbing Top Out Equipment. Enclosure Shower Pans O.K. for Finish Plaster Sewer -Lateral Pool'Cover Sewer Connectiona Z j�j���'X Encapsulation Gas Piping t Gas Test Appliances Final COMMENTS: inal fumity'Notice (Gas) • " ELECTRICAL APPROVALS emp Power. Pole R Underground Conduit Rough Wiring s Low Voltage Wiring Fbdures Main Service .Sub'Panels E)dertor• Receptacles - G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) r " - r.s t"* a`e'h�Wi'�"' ' �,� f ..0 GOAg4t�L y VAY: WATER DISTRfCT C49H RFOWPT PTA • + + i t a c�`"Aecelvod Fro `Addles$; t J. �• t Y (.1:' i t „� t T f e' Tract k"i1�.L._Q"aC� f $ervloe Address :Cl Mouse Laterel'(s) F , fc` r , .. • � di ` fF � %-�..3 y � �- a .. DeteatorCheok(s)d � I �*- +- j� �' a •�' - •* O MetefSUrohatpe !r `— anitatlon•GaPaol�y Charge ❑ .Temporary Construotion r }`❑ unooIIect'adAocountL` Inspeot�onFee Traoi= Fee °'i ❑ 'Plan Cgeck-F9essWater�/ Sewer �l Boni Ppymen't" A D _bond:. �— �+ . Asamt � Gu0tor�rerD�posi4'� *at � IA - Othef a �I ICTAL ! . Remarks. I� DCopy to:'[ ..' Cash Water 6erviO t e i t a Checks I r �-T e� Mp�ey � ' r ���,. �- *rte-, 3�e^ � i`,.a t:• '*G � + r;r Y ''' Gasliier ' ` `- ' � 4 t ROTO- 4DIvIsIon OOPlumbers of RotoCo., Inc. License Number: 422155 • Federal ID Numt B , �IM'c D,</-A(L1� / )B ADDRESS .S�1t1 IV �}y2 r� i !� q • TY N HEMET (909) 658-8541 ❑ LAKE ELSINOR'E (909) 674-2312 ❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555 WORK ORDER NO. 219572 ❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 ❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322-2622.z Z Q'SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346_-1736 DATE JOB # 796 N. STATE ST. • HEMET, CA 92543 Toll Free: (800) 491-7686 Fax: (909) 652-9515 TECH #1 /e//V/ TECH 42 1-800 GET ROTO (438-7686) 33-0475032 FIXTURE MAIN LINE: FT. ❑ BATH SINK - - - - - - -❑ FLOOR *DRAIN - - - - -❑ PURCHASE ORDER # CLEANED: TOILET - - - - - - - - - -❑ ,KITCHEN SINK - = .❑ FLOOR SINK ------- -T ------.❑ ❑ 9a>MiQCt STATE ZIP O. BATHTUB --------- ❑ LAUNDRY---------- AREA DRAIN------- SHOWER - - - - ----❑ URINAL -- -----------❑ OTHER ❑ 0 YES GUARANTEE 13 NO 8 A.M. - 5 P.M. MON. THIN FRI. TIME IN' TIME OUT Ni. COURTESY INSPECTION X U U VIP% % r%V1j DRAIN [:JCLEAN OUT D'ROOTS 1' GREASE 11, VENT �', EOTHER UNKNOWN UKAW4 t—LtAIVIIV17 11 ADD'L FOOTAGE ADD L FIXTURES i FIXTURE MAIN LINE OKILERv.�� N $ �'A� UTH: G1TY. ' PART NO DESCRIPTION /REM KS / EP RS NEEDED ./_ u%�� PRICE PLUMBING LABOR�.-� TOILE( �+ �r-�j �t t n � U / i� 41 _ PARTS I BATH TUB PRODUCTS/TREATMENT VIDEO INSPECTION SHOWER BATH SINK _KITCHEN SINK _ �� �q �n 6 : (lU i� ^ 0 - HYDRO JETTER MINI JETTER LINE LEAK LOCATION PUMP SEPTI -/GREASE - DISPOSAL LAUNDRY URINAL FLOOR DRAIN ❑! ❑Qt_ LLJ�� - tk.�.��1�t TAX TOTAL / PAYMENT RECEIVED FLOOR SINK AREA DRAIN WATER HEATER OC C/0 REQ. 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 F9 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 Si nature X WAIVER OF RIGHT TO CANCEL:' g , Pursuant to Section 9.13 of the California Civil Code. I acknowledge and hereby waive my right to cancel the sale within three cloys and acknowledge n /? that the products and services rendered hereunder are emergency repairs. 168 r Signature - % /� `•(/ t ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF ; r Acknowledgement3COmpleti0 Y� CUSTOMER COPY ; COND ONS AND EXCCILUERO S Roto -Rooter Service & Plumbing Co. guarantees the services perforri 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 paAv, ivastalled by Rolo.-Rooter Service is Plumbing Co. occurs. Roto -Router Service & Plumbing Co. will clear the drain stoppage or, repair or :replace (it 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 !hnitations: I . Tis Gtr.arant e Lpplies My m ;hc specific ,ower lines cleared. or olu,—nhinL; fixtures or plumbing parts supplicd and installed by foto-Rooter Service & Plumbing Co. 2. Roto -Rooter Service cL'•. Plumbiwv Co. must receive notice of the defect within the Guarantee Period. J. 'This Guarantee does not apply to: a. Multi Unit Dwellings sewer and drain litres, plumbing fixtures or plumbing parts. b. Materials furnished or work performed by other than Roto -Rooter Service & Plumbing Co. c. Drains. newer lines. plumbing fixtures and plumbing parts which have been misused, abused. damaged or modified by others: d. Drain sir sewer line stoppages caused by foreign objects, including but not limited to sanitary articles, paper towels, toys, etc.: or e. Sewee lines which are settled, broken, offset deteriorated, damaged or improperly or illegally installed. f. Drains;, sewer lines, plumbing fixtures on 'septic systems. g. Commerei d accounts. 4. The Guarantee Period cornmeiices on the date or original service and shall not be extended by subsequent services or repairs made pursuant to the terrus 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 part~: Roto -Rooter Service & Plumbing Co. shall not be liable for (1) Incidental or consequential damages: (2) !%later or other damage; (3) Lois 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 lie Plumbing Co. knew of the likelihood of such darnages. 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 cr"ortl. Tris guarantee may only bw modified in writing, signed by an officer of Rota-Rooe-r Service & Plumbing Co. 7. This gUarantee does not apply in the event customer breaches any of the Terms and Conditions of set -vice, including but not limited to timely payment of all charges. T ERtM8: NET "10 DAB'S. A FENANCIE 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 contractorsare regulated by lads 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 incivil 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 govermnent pages of. the white pages for the office nearest you or call (800) 321-CS.LB for more information." (Single) Family Owner Occupied 1. Basin, Tub, Slower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out :...90 days C� 2.- Sewer From Roof Vent (2- Roof Vent-& Guarantee)..................................10 days 3. Toilet Stoppage and ,area Draindays .................................................10 4. Single f=amily Rentai (Single Unit Only)...........................................30 days 5. All Plumbing, R,6pairs and Replacements...............................1 Year Parts & Labor COND ONS AND EXCCILUERO S Roto -Rooter Service & Plumbing Co. guarantees the services perforri 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 paAv, ivastalled by Rolo.-Rooter Service is Plumbing Co. occurs. Roto -Router Service & Plumbing Co. will clear the drain stoppage or, repair or :replace (it 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 !hnitations: I . Tis Gtr.arant e Lpplies My m ;hc specific ,ower lines cleared. or olu,—nhinL; fixtures or plumbing parts supplicd and installed by foto-Rooter Service & Plumbing Co. 2. Roto -Rooter Service cL'•. Plumbiwv Co. must receive notice of the defect within the Guarantee Period. J. 'This Guarantee does not apply to: a. Multi Unit Dwellings sewer and drain litres, plumbing fixtures or plumbing parts. b. Materials furnished or work performed by other than Roto -Rooter Service & Plumbing Co. c. Drains. newer lines. plumbing fixtures and plumbing parts which have been misused, abused. damaged or modified by others: d. Drain sir sewer line stoppages caused by foreign objects, including but not limited to sanitary articles, paper towels, toys, etc.: or e. Sewee lines which are settled, broken, offset deteriorated, damaged or improperly or illegally installed. f. Drains;, sewer lines, plumbing fixtures on 'septic systems. g. Commerei d accounts. 4. The Guarantee Period cornmeiices on the date or original service and shall not be extended by subsequent services or repairs made pursuant to the terrus 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 part~: Roto -Rooter Service & Plumbing Co. shall not be liable for (1) Incidental or consequential damages: (2) !%later or other damage; (3) Lois 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 lie Plumbing Co. knew of the likelihood of such darnages. 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 cr"ortl. Tris guarantee may only bw modified in writing, signed by an officer of Rota-Rooe-r Service & Plumbing Co. 7. This gUarantee does not apply in the event customer breaches any of the Terms and Conditions of set -vice, including but not limited to timely payment of all charges. T ERtM8: NET "10 DAB'S. A FENANCIE 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 contractorsare regulated by lads 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 incivil 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 govermnent pages of. the white pages for the office nearest you or call (800) 321-CS.LB for more information." 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 Stated 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 erhployer,,you must register with the State and Federal Government as an employerand 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 finaiic alpsks 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 other 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 maybe 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 flees G -C -off O. ER'S SIGNATURE/ DATE Yyo. P-vup K4m:re7 Lq 44; �. PROPERTY ADDRESS PERMIT NUMBER(s) ,3