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0206-177 (PLBG)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ch4er 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 4 23 5: C:36 C42 B .1,:.3,T,- 1/1 Ifi;.S 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: ( ) 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;) 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 STAT FUND Policy No. 10331YZ_02 r (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 tho,sye•provisions. Date: `�' '' tf';�` Applicant s! 'r n__- •, .� ' �°`j w•t ...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, indemnity & 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 state1hat 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 r,.mspection purposes. `Signature (Owner/Agent);' "'' !' �`F l�'`'i0� Date? BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT UNOM , ._,,�� - �j,_v JOB SITE ADDRESS &-, , %5 AMDAXXF.J0 9;3 - APN OWNER CONTRACTOR/DESIGNER/EN (NEER $e - 5 65 �LL "1. 7 67ST. .1,AQUWT.tk CA 92,253 TWAYi CA. 92543 (909)658-8,$41 GRIN. x060 l USE OF PERMIT SEPTIC A.13ANOOMy SF f+ EP HOOK -10 t tl 'oft VAL;€ ATX014 1,800.00 LS j EIRT9 `ATE ) COU.10F CONIVENUMION PERMT ITN SyRdWilR!i PL'iJM? INCY 14X. -� SEWBR. 101 _000-4e' A -O k WAD e r 0� [—ff.Y0r LAQUINTA FINANCE DEPT. �..,�. SU.€-TOT.1, 01O9011T T1-1014 ANS) PLAN CA YCk ` L=,1 PP.X PAW-jM?3 110.00 RECEIPT DATE ,� / (i BY i DAT FIN LED INSPECTOR 1 :.uz, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR ' . BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I + Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL AP ROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring ; Fixtures j Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 1$� «CCAQFiELLA VPLLEY WA�ER'DI3�i19T t h a - ' 'CASH RECEI77 PT r4.. Date' Vrc Received From �,... �, :: t . , .. ;., .� .°msmrs'' _- 1 l .; . ► i t t" V i i'T , . "/'� Serylce�'Address _ O'" Semca(s) ❑ Housb'Lateraf(s) w `Dotedtor Che .0) O" Meteraurohatge 3ar'Itatlon Capacity .-- 4. Temporary Construe 0 Turn,on Qgerge F p Uncollected Acoour f7 Inspection Fee'- L F® O Plan Chock Fees -N _0 Bond Payment - A O•°customer Deposlt. t } Q Other — ,i(F RemarKs =-r COPY bash - ,Check` Moneji s � 4 V 0 JOB CITY o ❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 ! lot= ❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699 0555 r WORK ORDER NO. 2 24855 r ❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 4. ❑ PERRIS (909) 657-9852 ElPALM SPRINGS/DHS (760) 32272622 a �� -_0 2_ ❑ SUN CITY (909) 679-8919 ❑' INDI'0/PALM DESERT (760) 346-1736 = DATEj JOB # f / Plumbers '. r -Toll Free: 800) 91 7686 F6: (909) 652 796 N. STATE ST. 9 HEMET, CA 9515 - TECH #1 tc (<" TEC H #2 _ _� Division of RotoCo., Inc. 1-800 GET ROTO (98-7686) + License Nur-ober: 422155 • Federal ID Number:23-0475032 FIXTURE MAIN LINE: FT ❑ BATH SINK - - - _ - -� FLOOR DRAIN - - - - -❑ NAME PURCHASE ORDER # j�� (''�� CLEANED: TOILET - - - - - - - - - - -❑ ; KITCHEN,SINK- - - - - -Q FLOOR SINK - - - - - - -❑ 7 - ZIP ...._ __..,— _ ,..... BATHTUB -------=-❑ LAUNDRY ------ ❑ AREA DRAIN -------❑ COURTESY INSPECTION OY ON X ED VIA D CLEAN OUT SHOWER --------- 0' URINAL ------ --❑ OTHER ❑ F YES GUARANTEE ❑ NO 8 A.M. - 5 P.M. MON. THRU FRI. TIME IN TIME OUT PLEASE INITIAL THE FOLLOWING:" ❑ CASH ❑ BILL,❑'CK # ❑ CREDIT CARD/TYPE A. The serviceman discussed Roto -Rooter products with me. r B. I have been advised additional lines cleaned at this time are half priced CC. EXP.DATE APPROV. # C: ' I have been advised -that running my main line from .a 3- roof vent is I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I improper access and can only be given a 10 day guarantee, a 2- main line has a am'agreeing to all charges incurred on this invoice and that the work was completed to my satisfaction. zero guarantee. In order to get a 90 day guarantee a, cleanout must be installed. IVER OF RIGHT TO ; ANCELCardholder Signature X Pursuant to Section 1689.13 of the California Civil Code. I acknowledge and hereby waive my right to cancel the sole within three days and acknowledge that the products and services rendered hereunder are emergency repairs. Signature' ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF Acknowledgement Completion CUSTOMER COPY EI r.-Pr�cfr�2 fE, E]EE Pr�r1�.t'r�r�cl�rPt_P�PrJ�r�t�rJ�� Pt Jr�cPrJ'arJ�tPrJ�i tJ�t !E� :: P�PrPcPr�r�c l�Pr�r�rJ�� PrJrPrJ�r1rJ�rJ�r�r� 5 o 0 LRe S Eben Hca Ouar � �� 5 5 5 �j 5 (Single) Family Owner Occupied 5 5 1:. Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days Z. Sewer From Roof Vent (2" Roof Vent e Guarantee) .............................. . ...10 days 5 a Toilet Stoppage and Area Draindays S 5 .................................................10 4. Single Family Rental (Single Unit Only)...........................................30 days �+ S 5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor 5 5 , O c.Iii:PrJ�r�t`Pc.Pr�r..Pr�rJ�r�r��Pr�r..Pr.PrScPr�cPrlcP>:.PrJfl�r�r_.lr�cPr�cPrJ�r�r�rJ�ci?.Pr�rJ�r�cPr�r�r�r�r�rlclr���PrJ�rJ�cntnrJ"r?Pr..PrJ� � CONDITIONS AND EXCLUSIONS Roto -Rooter Service & Plumbing Co. -uarantees the serxices perfonned as set forth,in this invoice to be free from defect in materials or workmariship for the -qppficable tine perW stated above. if within the Guarantee Period a drain stoppage or other defect in the repair of phunbing fixtur,:s or plumbing parts installed by Roto -Rooter Service & Plumbing Co. occurs. Roto -Router 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 limit2tion: 1. This Guarantee applies only to the. specific Sewer lines cleaned, or plumbing fixtures or plumbing parts supplied and installed by Roto -Rooter Senic: & Plumbing Co. ?. Roto -Router 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, A"laterials furnished or work performed by other than Roto -Rooter Service & Plumbing Co. c. Dram,, sewer lines, phi nbing fixture• and plumbing parts which have been misused, abused, damaged or modified by others: - d. }gain or sewer line stoppages caused hytbreign objects, including but not limited to sanitary articles, paper towels, toy's, etc.: or e. Sewer lilies which are settled. broken, offset deteriorated. damaged or improperly or illegally installed. f. brains, sewer lines. plumbing fixtures on septic systems. g.. Commercial accounts. 4. The Guarantee Period commences on the date or orininal service and shall not he 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 hahaity hereunder shall be limited to recleaning of drain or sewer stoppage (Max. two repeat visits) or ill, repair or replacement of defective plumbing fixture~ or plumbing parts: Roto Rooter Service & Plumbing Co. shall not be liable for (1) incidental or c`onseyuential damages; (21 Water or otter datttage. 1 3) Loss of use: or (4) L(n, of anticipated benefits or profits. any of which result from the furnishing of lien ices or products. or from the bleach of the Guarantee, even it Roto -Rooter Service & Plumbing Co. knew of the likelihood of such damages. h. Any impliLd warrant] of merchantability, or fitness for a particular purpose of use, shall he limited to the duration" of the foregoing written guarantee. The foregoing Britten guarantee is the customer's sole and exclusive remedy and in lieu of all other guaranties and „'arranties,-expressI or impli d tt ritten or oral. Thts guarantee may -only be modified in writing, signed by an officer of Rvto-Rooter Service & Plumbing Co. "`f hi; gu�rantre do%,, not apply in the event :ustomer breaches any of the Tents and Conditions of service. includima bltt not limited to timcfy pcq alt at cl all chars;.,, 71 RNIS; N1 r 10 1) WS. 1 FI1ANCE CHARGL will be computed on the unpaid b.iiance by a singh: period rate of I 1l2`r' ler month, which is an A.NNLAi 1l RCENTXGE RATE OF 18%,. ' • i ' tc I,.•• :, t, ., ar-• 1+rr_ i, hit, gun+rat, Gl d(+,rnst.u.ton a Irk to be l;c:ns;.d by Gr, t',tnh-agar, S[.dc License 13+mrd in the li.'anse categ(ny tri which 'r+i in[4G aCi+` i. +_•lf'l. ev 1Ie Nol0l_ it Ili' total pAo i the '•til ',,s NMI) -i r nort. (InclutfiiiL 1oho3 and waltr rial'). - f 1rJW ,r. _ �I` t !,•L., J�--,•r , t ,Itt., it I: I -ufl v%,oh,'fik't I ' r-, IC-Tt• IL The �i t <' 1(..3`i: . ..�•j•t gut. a �+. _',...,. ;'t 0A 't ry.*.. • a "tet-'" "11tH 'If ;kf 111..4 1-Y .n-,olil owrI Jtitl %'Our ray 0 ,I`F„ M oW •t .: 11,J.tt„ f4'; it +'(« . (1` '1C' �.! '-hL i d! Id((- -L Is ,i_ ! :-n• 1+ r ., J' I' v- rt,('J� . t„+ J �1i i ilt.::�_ Tt bl�.:rtf fi15t+`m�lil' i t�flilaltUn P'+ L�tC tltti('rt o. In ter ,tc., t:, tt, alt, 1.K,•.,t�i ,. f . x;T .. r. gin.: %t,tion ; h(. f.+a:d h„s otir.:s �ht lu,rtnllut ($ltfl+rota. Plc,t,e ttccl a t' • , r~•• cn; i,agc, of r.,te ,. _� he :,t+,% r u -if , , : telt)) 3,'l CSL$ for more tafornraUun'