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0403-216 (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 06 CAA B A. �- OiJ3112(. 4 ;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). ( ) I am exempt under Section , B&RC. 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. (k),, 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 STATE FUND . Policy No. 16M92-03 (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 provisions. Date;- M 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. 1` Signature (Owner/Agent) -v- - Date -R� :BUIIN_ PERMIT PERMIT# DATE VALUATIONp LOT 0403-216 TRACT MVIS/Zof, 003` 115M 0 ' ,l JOB SITE APN ADDRESS � )A I2AAURF OWNER CONTRACTOR / DESIGNER / EN (NEER ICA'n-MYYa M. BtId�.RRe�OWS ROM RC3MER 54.520.PAVY.WMA"1l,=i 796R STATF."T, LA. QISRM. CA 92253 HW'r'f CA .92513 (409)658-6541" CSLO 11360, USE OF PERMIT PI.t W-11NIG SEPTIC ABANDON- SIZWER CONNECT VALUATION 3.500.00 1 %TIE" ED coks f OF CONIRRITMON PMAW FEE ivTi'.TAWAdY P1.i1MB111,10 FM -- SL'M 101-000.419-000 fi 00 r11N104 TA r. d } 44U -TO T'AL CONSTWJC11011 A?T"T) PLA14 CRECK $_, 0.00 ' LESS :PRE-PAD3FM9 TUS.AL1!aERAW 1♦TIES DUE NOW RECEIPT DATE BY DAiE� I�yD L INSPE 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 & 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 I I 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 'Sewer Connection Encapsulation '-Gas Piping Gas Test Appliances _ Q Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbctures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: { F i � ,, '�'—. T Y�-a�•^"-,� W.�� �:r , ., : • T �r _ � ? W'4 F.D-�. at �.,.d "- x -, k ��7 .-"`i �' � � •-_ � 'ir'h 4 4 -t� 1 -� .I� S �� �ifw. � �' '�; rI �. ; r COACHFILA VALIFY WAT Ar R,`OffRICT i r :r CASH RtCEInNT40FTdILh6 :.t y ' t M1� , t� . ! t ! k Ley at�ly>Y-.f.7 "_`�)Y y f' #t • r' ` " Sil _ �1: Wiz: `_" F a 4� .— �j'..1-J JT L`j"r , 1 rl ail«lslT t1p+ t •� �_rY L\%a(4 i(ti'4" .LTi, - — -- `` � t! 1j ` i �. .{r, � � t o+ XFfij.T ��-��� � ^II'. t1 r I+i t:' ti� i�Y t r�' �`+ •�t..n .. �. 1 tAccount'ho ' s ?� ,� 1 lot4�)t '—_ — T-- --r rya Tract c k t �t r,5eMCe Addr098 °� • ;�� 1;9•� t t hl Co6 t. u rti } , i t• i ' . a. Meter(s} tt� ❑' Backflow(s)'•--z--- S r_ House Laterei( .) �' � r � Detector.Check(s� }t ,kt�—S frxM �j {�* ti ` LI Meter Surcharge 56nitetlorcCapacltyGharge r—� — -- za I , W.S.BFC ! �...... t , t j., :3 Tern porary Con struct)on'Meter --T t � 4 t a J Turn on Charge -- y ;• 0 Uncollected Account -Name - "— Inspection. Fee - •Tract - ! t Fee - Plan Chedk.Fges'Wgter.l Sewer } Tract D Bond Payment A.D. .—_90d...� J ' customer Deposit., =177=- ---..._ -- L Other_.—_: V 1 —'-- - TOT.AL a. fi Remarks: ,' r 4 `- -`- -T• } ,---�_ �� ,/ -f -_.._.-. -- '.:� ., 1..... ... -.. .� .�...i. ..trt.........+°•rs Sf'.�.r7,�r. ❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 ®� MOT❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555 RDOTERII ❑ BEAUMONT (909) 845.3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 ❑ PERRIS (909) 657-9852 - ❑ PALM SPRINGSIDHS (760) 322-2622 ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346-1736 Plumbers Division of RotoCo.. Inc. License Number 422155 • Federal ID Number: 33-0475032 ❑ FALLBRO.OK & BONSALL (760) 728-7497 ❑ OCEANSIDE, CARLSBAD (760) 722.3155 ❑ VISTA & TRI -CITIES AREA (760) 726.6260 ❑ ENCINITAS & CARDIFF (760) 7532674 ❑ DEL MAR & SOaN' A BEACH (858) 481-1633 Cl WEST RANCHO BERNARDO & WORK ORDER NO. WEST RANCHO PENASOUITOS (858) 484-2138 ❑LAKE SAN MARCOS & LA COSTA (760) 726-6720 269140 ❑ RANCHO SANTA FE & OLIVEHAIN (858) 756-3396 DATE&- �,:5..-fe)-'-'1/J013 # '................. ............... .................... IWOFI.01041C.OMMI nCMC1,VA`JZ,•9J - ' '// _ Toll Free: (800) 491-7686 • Fax: (909) 652-9515 • 1-800 GET ROTO (438-7686)1. TECH #1........ j�..!...�' �. 5.... TECH #2 .............................................. FIXTURE MAIN LINE: FT ❑ BATH SINK - - - - - - - -ij FLOOR DRAIN - - - - -U -CLEANED: TOILET -----=------0 KITCHEN SINK -----0 FLOOR SINK -------0 BATHTUB ----==-1-1 LAUNDRY -- - - - - - -M AREA DRAIN -------0 SHOWER ----------❑ URINAL -----------0 • OTHER 01'.'' ACCESSED VIA CAUSE OF STOPPAGE ` J O DRAIN ❑ CLEAN OUT ❑ ROOTS O GREASE O VENT OOTHER ❑UNKNOWN TIME IN TIME OUT YES GUARANTEE El NO 8 A.M. - 5 P.M. MON. THRU FRI. 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 -Roofer is not responsible for broken, settled, rusted, deteriorated, or lead pipes, fixtures, or clean outs and any damage resulHng4rom cleaning or repairing such lines. I have asked Roto -tooter 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 NAM � (SIGNATURE) COMPLETION i acknowledge completion of the above described work which has been done to my complete satisfaction. (SIGNATURE) - DRAIN CLEANING $ ; ADD -L FOOTAGE ADD'L FIXTURE$ a ., , „..,RESIDENTIAL GUARANTEE LABOR Main/8r�11ch Lines ... ... ❑ 66 months s ' ' Toilet Aul"" ...:............... ❑ 7 days Plumbt i epair ............. ❑ 6 months Plumbing Replacement ...... ❑ 1 year Extended Guarantee ......... ❑' 1 year PLUMBING LABOR PARTS PRODUCTS/TREATMENT _..__ _._._., , COMMERCIAL GUARANTEE_ LnsoR VIDEO INSPECTION Toin/Branch ones .............. 0 30 days Toilet Auger ............ 0 24 hours PlumbingRe air ......... O 90 da s p y t ing Replacement mbcemen., Y_.._, 090 days __mow _ - ._ REASON:ORNOGUARANIEE ; ADDITIONAL WORK REQUIREMENT, 9TY.' PART NO. �`""�'`""� .,.....J . i DESCRIPTION REMARKS REPAIRS NEEDED / / •��,� �%� '` - PRICE ,.r... HYDRO-JETTER - • .. MINI JETTER -...-.., LINE/ LEAK LOCATION PUMP SEPTIC/GREASE BOTHER TAX TOTAL PAYMENT RECEIVED - _ . 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. rc %-1 CLEAN UP 0 EXCELLENT ❑ SATISFACTORY . 1,O POOR CUSTOMER COPY CC EXRDATE APPROV hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below 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 ❑ BILL ❑ CK # ❑ CREDIT CARD/TYPE +�. • . -1 .- s. ff CONDITIONS AND EXCLUSIONS Roto -Rooter Service & Plumbing Co. guarantees the servicesperformed 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 fot (I) 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 t8%. 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 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-CSLB for more information! L )