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0301-125 (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 Q36 C42, AA,: 911 Date.,/— 2 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).1 . ( ). 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 petformance 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: Carrier STAff :Wt7'1 jD Policy No. 161833 _02 (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. C a.. Date:/ Applicant 'f ' e --- Warning: - "Warning: Failure�to'§ecure 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 or 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 applicator 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 91kPity, 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. Signature (Owner/Agent) , Date �, rY -.=BUILDING PERMIT PERMIT# _ DATE VALUATION ` LOT TRACT JOB SITE APN ADDRESSOV rJ�ik� VEoiFa�a� OWNER CONTRACTOR/DESIGNER/EN (NEER tEG'SY. T. Is"PR"tUM 1110TO int-001MI 53.-345 A : :I?A'JAI.'1: JO 196.8 +rf. T Be VT. T,.,A C'm"ITA. CA 9 253 TlY2YffiT .. CA 912,513 (909)658v8-341 CTJ#� 1060 USE OF PERMIT SEPTIC AS.ANOCINMKH'Y;°S&1%JZR 1100K.Url VALUATION ink. t ESTINWM, COMT Q2H' CO.IOMYCIr1rO1N ;BEEF �;.IJia�%e1 S�"+ t� !? -� 1± ► C 101.000"419-000 $30M WS -'1 rAL, COrJIMIU'c:' ION AND PLAN ClafFCK $730,00 PF "TFIT S30.00 2003 CITY OF LA QUI?JTA FINANCE DEPT. RECEIPT DATE BYDAT1 FIN LED INSPEC. 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 SKbwer Pans O.K. 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 of Power Final Utility Notice (Perm) COMMENTS: COACHELLA VALLEY WATER DISTRICT I CASH RECEIPT DETAIL 9 94093 r� �� �C...� % '�f " •/ b� ��% "��P,l ,iii i" Received From: Date: r t' Address: . i. _. • => y' VG.sf A (._Ll"":, YO z Gi l aV f. Account No.lrJC �lr�l�wrcl 4J (✓�% Lot(s) Tract— Se rvice ractService AddressG.A. Code ❑ Meter(s) i ❑ Service(s) ❑ Backflow(s) f ❑ House Lateral(s) r '• ❑ DetectorCheck(s) ❑ Meter Surcharge i. r%.Sanitation Capacity Charge i ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ ' Uncollected Account - Name ' ❑ Inspection Fee - Tract -• Fee - A ❑ Plan Check Fees Water I Sewer - Tract - t" E• ❑ " Bond Payment - A.D. - Bond c t Assmt. ❑ Customer Deposit i` 'r ❑ Other TOTAL Remarks: /10 Copy to: u ! Y CashWater Service Check � .` r �iJ F�'� � f�• � Money Order Cashiertf� uY's< a CVWD-438(11/99) r r Mo 10270 t :Division OTER® ' Plumbers of RotoCo., Inc: License Number: 422155 • Federal ID Numk JOB NAME a JOB ADDRESS a 0Ur N COURTESY INSPECTION OY ON X QTY D HEMET (000) 658 8541 ❑ LAIC, ELSI DRE (909) 074-2312 ❑ BANNING (909) 922-9491 -r;4 ❑ RANCHO/TEMECULA (909) 699-0555 WORK ORDER NO. -23715,0- El 23715'0 - ❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 .•M ;S. r . ❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322-2622 ❑ 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: (969) 652-9515 or t 4: TECH;#1 �! y TECH #2 1-800 GET ROTO (438-7686) _ )475032 MAIN LINE: FT ❑ ' BATH'SINK = -❑ FLOOR DRAIN `, ❑, FIXTURE:. , PURCHASE ORDER a - - - -❑ KITCHEN SINK - - -❑ FLOOR SINK ;.- ''= �• Ft � TOILET,- -� CLEANED BATH TUB -' ' - - ❑ LAUNDRY ❑ AREA DRAIN ' - (% SHOWER0. - - - °❑ URINAL -y 'i ' -p OTHER ❑ STATE ZIP ❑ YES GUARANTEE _i. ❑' NO ACCESSI ❑ DRAIN VENT PART NO. VIA El CLEAN OUT .f 8 A.M. - 5 P.M. MON. THRU FRI. :TIME IN TIME OUT,_ CAUSE OF STOPPAGE 0ROOTS DGREASE DOTHER OUNKNOWN DESCRIPTION / REMARKS / REPAIRS NEEDED �� PRICE f � 9 PLEASE INITIAL THE FOLLOWING: "" -0 CASH El BILL ❑ CK # ❑ CREDIT•CARD/TYPE A:.. The serviceman discussed Roto -Rooter products with me. �` �� Y B. • I have been advised additional lines cleaned at this time are half priced CC " t' ' 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.' ` WAIVER OF RIGHT TO CANCEL: ' Cardholder Signature X Pursuant_to Section 1689.13 of the California Civil Code. I acknowledge and hereby waive my right to cancel the sale within three days and acknowledgesthat the products and services rendered hereunder are emergency repairs. Signature a ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF i k' ;. • ' Acknowledgement Completion CUSTOMER COPY ` ` a t rr�t��r_n��t�� n�nLn���r���r-�t��n� rt��n�t_r���r_nr��n�� n� r�rs�t_n�r� r. r�rr�r��r3�u�n��n�Lts�PLfl n��nJ a NJ 5 NJ (Single) Family Owner Occupied c5 5 1. Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days 5 5 5 2. Sewer From Roof Vent 2 Roof Vent -&Guarantee .............10 days 3. Toilet Stoppage and Area Draindays 5 5 ...................................:.............10 4. Single Family Rental (Single Unit Only)...........................................30 days 5 C� 5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor CJ O r�cft:.PrJ�t:PcPiJ�r�r�r�r�r..PrJ�rJ�r�r:Pt:.1c1�r�rJ��PrPr�r�r�rJ�r�r�rJ�i�iJ�rJ�rJ�rJ���Pr:Pc_I"i:.ft:.l�rJ�rJ�i�rJ�rJ�rJ�r�cJ�cP�Pr�rJ�r.Pr_l�cJ�rJ�r�rlr.P � 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, soh e -,.r f.) 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 perfonned by other than Roto -Rooter Service & Plumbing Co. c. Drains. sewer Fries, 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; C-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 trom 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 die 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 Terns and Conditions of service. including but not limited to timely payment of all charges. TERMS: NET 10 DAB'S. 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 covet, 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"