0304-306 (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 •i
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:
( +j. r,.as owner' -of the property, or my employees with wages as theii..soie
compensation, will do the work, and the structure is not intended or offered. for
sale (See; 70441business & Professionals Code).
( ) owner;of:"the property, am exclusively contracting with licensed
contractors .to construct the- project (Sec. 7044, Business & Professionals
Code
r
O I am.'exempt under. Section B&P.C. for,this reason
Y
.Date '}`+E Signature of Owner `
WORKER'S COMPENSATION DECLARATION
I hereby;4affirm under penalty of perjury one .of the following declarations --
c: ); I.'fiave"and wil6maintain a certificate of consent to self -insure for wo`rk'ers'
compensation, as provided for by Section 3700 of the- Labor Code for,the
performance of the work ,.for wfi'ich this permit is issued.
( ),!,Have 'and will maintain workers' compensation Insurance; as required by
-8e6ti6n;,'3700-of-the Labor Code, for the performance of the.work for which this
permit -ds issued My, workers', -compensation insurance carrier & policy no. are:
Camer Policy No.
t- i :y
(This section need n i,b' tompleited if the permit valuation is for $100.00 or less).
( ) .I certify that' In the- performance of the work for which this pefmit is issued,
I shall :not employ any peisbon in any manner so as•to become subject to the.
workers' compensation laws of California, and agree that'if 1 should become
subjectitothe workers' compensation provisions of Section. 3700 of the Labor
'.Code I'shall-forthwdh c6mplyw4h those provisions.
A`'Applicant [ r
! ',r N
Warning: Failure to secure,Wgrkers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties'and ci4il'fines up to $100,000, in
addition to.the cost of compensation, dam'ages'as provided for in Sectiori 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.
Jr
,Signature (Owner/Agent) �.�. --. Date ' ^ '%
BUILDING PERMIT PERMIT
DATE ttfr�wt/.� VALUATION LOT LOT TRACT
JOB SITE
ADDRESS •L-SDE&D 4� CIJ"E� ,Zs2 A+'.i1 #i'.
APN .
OWNER
CONTRACTOR / DESIGNER / EN INEER
1"'As W3LLT:AM3 .. ;
t�'Sri3 f+ �-1•<;}ii,T '1 �
S 1.060 diitIV9. XJ!1tkX1RRTA` -N ' I
LA'ij}3X'i'A �i�k;r•, '�:Y 3
USE OF PERMIT s
',�Z.e'yi,','i✓4
K". 01
I S t
y ,
�l'i�-'T't�'6'd�L G�2:�}; 4'd":� ?:`.'�3:t��:s�)';�kT! a �''L Jt)`� f��C',•f�.
`'s�:4f1. iat:P
Yr
WROW
P
APR 2 51. 003
CC' fq;j N� . .
[RECEIPT
DATE
BY
DAT6.FINALED
INSPECTOR
INSPECTION RECORD
I S.
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
BL-OCKWALL APPROVALS
POOLS - SPAS
steel
Set; Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
' •---PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
~Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer,Lateral
Pool Cover
Sewer Connection
.0 (_
Encapsulation
Gas Piping -
Gas Test
Appliances
Final
77
Firiaiw� _._ - -
Vtility'Notice (Gas):
ELECTRICAL APPROVALS
Temp:�PowerkPole
Underground Conduit
RoughWidng •
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
.-Temp. Use of Poveer
Final
Utility Notice (Perm)
COMMENTS:
- • ..
"
t
= '
f
t
COACHELLA VAL4 4Y`WATHFI OISTRIOT
CASH RQOiI 'T DERAIL. r $4940
Received From: •• T
Aggoaarit No. �'� �•u'+►3 �4-. ' • i- fat;} . Tract__
Swv"ASidteS9 Q.A, Code
p $ervlce(er_ ,,,w
G� $aoktlaW(s) -
C House-Lateral(s)
�F 040ctwCha4k($)
CI MeterSureharge
,� 8anftetieln Gap8rxlty ChlEtirge � ,
Q Temporary 0onctructlonMeter
0 Turn on Charge
a
0 Uncollected Account - tigme,,
Impeatton Fee - Tract -
>=ee -
0 A4M Cock Fees tAfgter a Sewer
T"Wt -
Q Sona Pa&ent - AO. - Bond
As t,
97 >; 4tarwoeposlt
Q Other
TOTAL $
r .•
Rernerka it
Oak 13R3 ,t', l WaterBervtoas i
ow Cashier
Cashkery
Qrder % CVWD-aa9 (17 r89)
t
ROTO- r
41DIvIslon
OOTER®
Plumbers
of RotoCo- Inc.
License Number: 422155 • Federal ID Numt
NAME p�
(l/l�► r/ir i�tCr `
CITY
�t'-c
COURTESY INSPECTION Y 0
�X
FIXTURE JIOK I1 Eav $ -- IiAUTH
MAIN LINE
1'
TOILET iI
BATH TUB -
F —
HOWER
BATH SINK -
KITCHEN SINK IL -jL--JLL -
DISPOSALT�l�
- — -.--
LAUNDRY �� E
URINAL
FLOORDRAIN
FLOOR SINK
—:- -
AREA DRAIN yl
WATER HEATER I
C/O REQ.
11
❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 f
•❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555 ; WORK ORDER NO. 250364
❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 •.
❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322-2622
El SUN CITY (909) 679-8919 INDIO/PALM DESERT (760) 346-1736 DATE, . 6: �-'�2:4OB # _
796 N. STATE ST. • HEMET, CA 92543
Toil Free: (800) 491-7686 Fax: (909) 652-9515 TEC�)#I /� 5'- TECH #2
1-800 GET ROTO (438-7686)
0475032 - FIXTURE .. MAINLINE: FT ❑ BATH SINK - - - - - - - -❑ FLOOR DRAIN - - - - -❑
PURCHASE ORDER #
CLEANED:. TOILET ----------- El KITCHEN SINK ----- 11 FLOOR SINK -------❑
BATHTUB ----- ----❑ LAUNDRY ---------❑ AREA DRAIN -------❑
SHOWER ---------❑ URINAL -----------❑ OTHER ❑
STATE ZIP ❑ YES , GUARANTEE NO
8 A.M. - 5 P.M. MON. THRU FRI. TIME IN TIME OUT
ACCESSED VIA CAUSE OF STOPPAGE
C DRAIN C CLEAN OUT Q ROOTS GREASE
VENT O OTHER UNKNOWN
'QTY. i PART NO. DESCRIPTION / REMARKS / REPAIRS NEEDED i PRICE
-6t
�f
I
1`
i I
' u
PLEASE INITIAL THE FOLLOWING:
A. The serviceman discussed Roto -Rooter products with me.
DRAIN CLEANING $
ADD'L FOOTAGE i
ADD'L FIXTURES _= ---_-il
PLUMBING LABOR
PARTS
,PRODUCTS/TREATMENT
VIDEO INSPECTION !I
HYDRO JETTER
MINI JETTER
LINE/ LEAK LOCATION
PUMP SEPTIC/GREASE�I �^-
--
OTHER
TAX
TOTAL �{
PAYMENT RECEIVED
❑ CASH ❑ BILL 0K # b/� ❑ CREDIT CARD/TYPE
B. I have been advised additional lines cleaned at this time are half priced I CC EXRDATE 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 acknowledge
that the products and services rendered hereunder are emergency repoirs. Signature
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF 4 Acknowledgement Completion
CUSTOMER COPY
o�n�ntst��tsr
nL: 2 n�nts� l-��rsrsr��n�l-�rr��n�l-rs���r��ts�l-rs�l-�n�lt_n�n�nr��nrst_n�n��nt���n�n�L�r�LP�
a
S(Single)
Family Owner Occupied
5
5
1. Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days
5
5
2. Sewer From Roof Vent (2" Roof Vent$ Guarantee)..................................10 days
3. Toilet Stoppage and Area Draindays
5
5
C
.................................................10
4. Single Family Rental (Single Unit Only)...........................................30 days
rcj
5j
5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor
5
o
s������rrs�rr���trrs:rn ---nrr
r�rs�r�r�r�n��t��nr�r�
a�
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,
subject to the following exclusions and limitations:
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.
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 litre 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 commenFes 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`,hereander 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 resulf.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.
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•Lice`Ze' 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 cQ}rtractors are regulated by laws designed to prratect the public. If you contract with someone who does not have a license. The Contractors
State Licenl.,e 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 damage's arising out of any injuries to the contractor or his or her employees.
You may contr4t the Contactors 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."
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/ 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 State of 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.
rJ ..
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
-- _ to several -obi igations including_ State, and Federal income tax withholding, federal sorial security taxes, worker's
compensation insurance, disability insurance costs and.unemploymeni compensatiogcontributions.
There may. be financial risks 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 Stare
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 or her 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 may be 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
LaInca CA 92253
(7 0) 777 012
F (760 777-7011
'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(s)