Loading...
0108-265 (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 Licensa is in full fnrre Rnri effert License # Lic. Class Exp. Date 422 115 .4 C36 C42 :Date `= X't, A Signature of Contractor -7 —T --.y— jy.. ✓ 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. (..o) I have and will maintain workers' compensation insurance, as required by Sation 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 f`% 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. e Applicant- 7 pplicant ✓' r Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his Application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify &• hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. 1Signature (Owner/Agent)? • y��' Date e" BUILDING PERMIT PERMIT# DATE VALUATION LOT 05 TRACT JOB SITE APN ADDRESS T1-5 T1 ­5M CALVE SONORA 71M.23$_011 OWNEWt CONTRACTOR / DESIGNER / ENGINEER T• MAN C�IAL Tr"t OREO 0 Tt��!�`}��,1 �Iy�� MNIS:�y✓/v&4� (�� {� C7- / 8 tl/L• UA.01,10 O- V, Q^ semi •�A/W I Ur ]LL.ii.l u 1 r. 'Q(7.1IN'1A Ch 92253 RMAET CA 92543 (909)9 558.85 41 CTU 1060 USE OF PERMIT 9A"&EFff:RHOOF:«I,3'.P, QfOTIC A13AN'DO_ '� (,LaW•MOD PFiLt1FC i WW -01* U18"r rS,t 11 C 019T 010 CON�'",k,NUQ."'. ION 1,695.00 PLISM.3sNO F,ER 101 -000-419-M SAN La p - D SEP 18 2001 CITY OF LA QUINTA FINANCE DEPT. €1'(M-�".t J.f�3. C0NffPAX %0X AM i9Z,.AR 01JECK 1X33 EA-P,'`�Tf7w $0,00. RECEIPT DATE BY DATE FINALED INSPECTOR 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 2 - Final Final 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 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 Final COMMENTS: 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) HEMET (909) 658-8541 ` D LAKE" ELSINORE (909) 674-2312 r , • r .4 ,' Z I+.. ' 1" © BANNING (909) 922 9491 ❑ RANCHO/TEMECULA (909) §99-0555 ` ; � . , WORK ORDER NO '207"57. � .r' r °B,EAUMONT(9u9)•845-3338 ��❑'REDLANUSIYUI`:All'A(yUy)/y/---kfby/ 4...,�,:, ,• '+�, �, r FS �:-, , +61 #,,p , ,! aillo ��E p PERRIS (909) 657-9852,, '.❑'PALM SPRINGS/DHS (760)322-2622, "' ( ) ( ) DATE/ SUN CITY. 909 679-8919 INDIO%PALM DESERT 760 346 1736 ; .r:_ ®i off' JOB 4 ` +' 796 N; STATE ST. • HEAAET, CA 92543 Plumbers - i �� . tisk, f Toll Free: (800) 491-7686 Fax; (909) 652 9515. y TECH^#1 - +' -'S TECH #2 _ % �- DlVlslon bf R:ot060.', Inc. l 1-800 GET R0T0 (438-7686)' �• •,„ x, :� r � - k �, ber, 33-0475032 r "'- License Number: 422155 Federal ID Num _ �• • FIX MAIN LINE ❑ BATH SINK ❑ FLOOR DRAIN "s -❑ JOB NAME - ".irr,�;-;" ,' ,"" •.� .PURCHASE ORDER # ' I ;•y ; TUBE FT • s` : " •• — '� �J TOILET - - - - - - ---0` . KITCHEN SINK - FLOOR SINK ------- CLEANED. - - - CLEA E�D. � =❑ JOB ADDRESS; _ BATH TUB ------ -� LAUNDRY - ❑ AREA=DR - - - -❑ ,Y r 7`' - -OTHER- 2; � SHOWER � URINALS ,• CITY `STATE"""",—ZIP a 1",Y 3 X - ES GUARANTEE N0. n "._TIMEIN • � ``: ¢ TIME OUT (.�' lr i.� i` c•`` ' � A:M .- 5 P.M. MON.TTHRU FRI: `COURTESY INSPECTION O ON STOPPAGE ��` ACCESSED VIA CAUSE OF DRAIN CLEANING L$ AN GREASE 3 • DRAIN ROOTS - X y f W N ❑CLE OUT ❑� ❑•VENT+ ❑'O r '❑'UNKNOWN`'' ADD'L FOOTAGE ti THER FIXTURE OK SERV. $ AUTH. 9TY. r PART,NO " ' DESCRIPTION / REMARKS/ REPAIRS NEEDED `• PRICE ADDT FIXTURES r �� NEED �� � MAIN LINE QO fL ' PLUMBING LABOR' ,TOILET- ��''� jjjj��""f}��.,lit� , r PARTS t BATH TUB �� --a✓t_ _ _O rCJr _lJd PRODUCTS/TREATMENT �� VIDEO INSPECTION ,SHOWER❑�t.�L_ 77;41-:Z - - BATH SINK ®O� o �� ? HYDRO JETTER — KITCHEN SINK ["�� ❑®�t -- • � /' n �•' MINI JETTER r rDISPOSAU ��� _� 'LINE/ LEAK LOCATION LAUNDRY, 7,��f✓'"" , PUMP SEPTIC/GREASE URINAL�� CJ OTHER FLOOR DRAIN�� .�t # FLOOR SINK F J t ' .TAX AREA DRAIN TOTAL - OQ + PAYMENT RECEIVED WATER HEATER C%O REB. h 'PLEASE INITIAL THE FOLLOWING: , i F , It - •1 �' - • , ❑ CASH ❑ BILL El CK # ❑ CREDIT: CARD/TYPE _ A.- The serviceman discussed Roto -Rooter products with me. B 4 : w ' I have b'eenradvised additional lines cleaned at this time are half priced `C C L EXRDATE APPROV. # .� I have been,advised thatyr6nning, my, main• linerfrom a 3 "• roof vent' ls, ° I hereby authorize Rococo, Inc: fo charge my Credit Card for the above charges` l understand That by signing below l ., V- Z6_7 • improper access aril can only be given a 10 day guarantee; a 2 ", main Jine'has a. am ag eeirig to &I charges incurred on this invoice'and that 1, work was completed to my satisfaction, zero guarantee In order to get a 90 day guarantee a,icleanout must be installed c k�x Cardholder Signature X • ► ,WAIVER OF RIGHT TO CANCEL'j, - - e Pursuant to _Section,1689.13 at the California (f Code, I acknowledge and hereby waive my right to concel the sale within three days and acknowledge , • " x.� , t ` ti •_ :� " that twe products and services rendered Hereunder are emergency repovs. a Signdtur@ 1 �' ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF µ ` `' t , 1 ' , Acknowledgement Completion a CUSTOMER COPY o �n�����n��-�FL pIE��_�LL� o s_06u a r a n te eculesibenti"al "I 5 5 -(Single) Family Owner Occupied 5 S1. 5 Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days 2. Sewer From Roof Vent (2- Roof Vent$ Guarantee)..................................10 days 5 5 3. Toilet Stoppage and Area Draindays 5 Cj .................................................10 4. Single Famil Rental (Single Unit Only)...........................................30 days S C, 5 5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor a �.r�E, n: , �ffnr'��n��r�ts����t .r��nr.l?r:n��.nr_nt��rs�t.r�t rt r�� rr��.r�n�.n�n�r:n� r�nr��r_n�����tr�����r.r� o CONDITIONS AND EXCLUSIONS ��CRoto y -.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: y 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.hereu.nder 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 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. SRI S: 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 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."