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0207-127 (PLBG)V U) ( W O :3 M CYW IY o Z ti CD O H CD � LU CLN Z M LO N ON U °) QL Q Lo acc 0 XW !L 0 _JCD < O d rn H Z_ co 5 r d Q J 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 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 %-4 X- C�Z —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 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 Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). ,(r) 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, _proJ ions. Date: -_� _ 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 f r.,In pection purposes. Signature (Owner/Agent) �PX,g 17 Date all BUILQING"PERMIT PERMIT# z;? , 02'07-aa1 DATE TRACT 3 2 0y LOT [t 7 y /� X VALUATION $312W.00 43 /I�d �tl6till. t1°y4f.�fJ W JOB SITE "' APN ADDRESS &J_3. jAyr,,.�►I.�-�AI'J'.1�.�'MA - OWNER CONTRACTOR/DESIGNER/EN (NEER LA,. (ZC1NTA CA 92253 USE OF PERMIT a;'UT.I M11-NJCa- 3=, F,1; C C)NRi&CTISZ'E'+C: APIANL1ONEMIrN T. :L:Ir°I'i34AUM COST OF C0119r..R"'1YMON :�„►C�.E� I'p.UAd1�1 C� ItP.E -- SWE;K 101-000-419-000 TA00 s. 911-TOX17AL 0ON:;TRUIC 1:tM it.11D P.1Ai+T CHECK CIT'YOFLAQUINTA r } FINANCEDEPT..-.---) RECEIPT DATE �/ BY�� D FIN LED INSPECTO /ice 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 Wali Insulation Condensate Lines Party Wali 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 Pibg. 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 O.K. for Finish Plaster '. Sewer Lateral Pool Cover _ Sewer Connection — y/L_ / 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: Received From COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Q 90 -'80 Dale: Address: I—A Account No.' Lot(,) "S Tract. Service Address G.A. Code • Meter(s) • Service(s) • Backflow(s) • House Laterals) • Detector Check(s) 0 Meter Surcharge R� Si;ltation Capacity Charge Q W.S.B.F.C. 0 Temporary Construction Meter Q Turn on Charge 0 Uncollected Account - Name CI Inspection Fee - Tract - Fee - 0 Plan Check Fees Water Sewer - Tract - Bond Payment - A.D. --Bond Assml C1 Customer Deposit C3 Other TOTAL Remarks: Av .13 copy to: Cash Check );J I Money Order I Water Serviceo Cashier CVWD-436(11/89) c.LJLIO�O� ❑ HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 ❑ BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699-0555 4DIvIsIon ODTE ElBEAUMONT (909) 845 3338 ❑ REDLANDS/YUCAIPA (909) 797 8697 R ❑ PERRIS (909) 657-9852 ElPALM SPRINGS/DHS (760) 322-2622 umb' I . ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346-1736 ers 796 N. STATE ST. • HEMET, CA 92543 Toll Free: (800) 491-7686 Fax: (909) 652-9515 of RotoCo., Inc. 1-800 GET ROTO (438-7686) License Number: 422155 • Federal ID Number: 33-0475032 FIXTURE MAIN LINE: I Tk K- z Ln.,j-f -?-- PURCHASE ORDER # CLEANED: TOILET - - - - - FIXTURE �OK I[NEED RDiL.— r _ MAIN LINE rolLEr � + BATH TUB SHOWER BATH SINK '1 r77' T II KITCHEN SINK DISPOSAL LAUNDRY _ URINAL FLOOR DRAIN FLOOR SINK AREA DRAIN WATER HEATER C/O REQ. QTY. PART NO. PLEASE INITIAL THE FOLLOWING: A. The serviceman discussed Roto -Rooter products with me. r ^� RK ORDER NO. 22 V DAT /C) JOB#_�_� TECH #1���-� TECH #2 --------❑ FLOOR DRAIN -----❑ KITCHEN'SINK - - - - -O FLOOR SINK - - - - - - -❑ ---------❑ AREA DRAIN -------❑ SHOWER ---------❑ URINAL-----------1� ❑ YES GUARANTEE NO 8 A.M. — 5 P.M. MON. THRU FRI. TIME IN DESCRIPTION / REMARKS / REPAIRS NEEDED PRICE --q W At3 I, ST� +I-\ L(.1.K-r,\ OTHER - ❑ TIME OUT 'DRAIN CLEANING ADD'L FOOTAGE C ADDT FIXTURES C PLUMBING LABOR PARTS PRODUCTS/TREATMENT it VIDEO INSPECTION ¢ i�- I# HYDRO JETTER II MINI JETTER I - _ LINE/ LEAK.LOCATION (� PUMPSEP_TJC/GREASE � OTHER TAX f------- I TOTAL4/0 iJ PAYMENT RECEIVED 1 5 B. I have been advised additional lines cleaned at this time are half priced C. I have been advised that rdnning 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 90 day guarantee a cleanout must be Installed. WAIVER OF RIGHT TO CANCEL: Pursuant to Section 1689.13 of the California Civil Code. I acknowledge and hereby waive my right to cancel the sale within that the products and services rendered hereunder are emergency repairs. ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF CUSTOMER COPY ❑ CASH ❑ BILL I/CK # �� ❑ CREDIT CARD/TYPE CC EXRDATE t' APPROV. # I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I am agreeing to all charges incurred on this invoice and that the work was completed to my satisfaction. " f Cardholder Signature X hree'days and acknowledge Signature Acknowledgement Completion -ink I _ 13 t.Pr�rJ�cia�Pr;PrJrJ-r_-P�rJr�rJcPcJctt?ff�rl�i�rJ�r�rJ�r.Ioctr�P�P t Pr��Pu�rJ�r�r�r�rJ�r�cPr���P>=1P�.i�cP rJ�cn�rJ��Pr_1�r�cPrJ�r�LPu'� a 5 ? Y .ems tis Utarau (Single) Family Owner Occupied Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days Rj S. 5 Sewer From Roof Vent (2" Roof •Vent-&Guarantee)...................................10 days Toilet Stoppage and Area Drain .................................. .10 days 4.- Single Family Renta) (Single. Unit Only)...........................................30 days 5 All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor 5 rJ� cP rnrJ�r�r�[nr�[PrJrl�i 1�[ (�[ J�[Pr�r��P[.1Pt.nrn� !J2Pr�r��� 0,10,1121 DIUtJrJ�r�J�i J01E I�rJ�r�[P[Pt:1t:Pr�rJ�cJ�i �r�� f�fCQPrJ�cPJIMI ,t #= 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 we mantihip for the applicable time period stated above. If within the Guarantee Period a drain stoppage or other defect in the repair of plumbing fixtutzs or plumbing parts installed by Roto -Rooter Service & Plumbing Co. occurs. Roto -Rooter Service & Plumbing Co. will clear the drain stoppage or, rep.ur or replace (at -Roto -Rooter Service & Plumbing Co.'s option) the plumbing fixture or plumbing part previously installed at no cost to customer, subject t:o-die 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. S. 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_ Arains, sewer lines, plumbing fixtures and plumbing parts which have been misused. abused. damaged or modified"by others; : z -fl Trainor sewer line stoppages caused by foreign objects, including but not limited to sanitary articles, papek towels, toys, etc,: or C. ;Sewetlines which are settled, broken, offset deteriorated. damaged or improperly or illegally installed. r}.Draibs,sewer lines. phuntiing fixtures onsepticsystems. g. Commercial accounts. 4, The Guarantee -Period commences on the date or original service and shallnot be extended by subsequent services or repairs made pursuant to tlielsrrrrrs of the Guarantee. The Guarantee hereunder extends to tbo customer invoiced for the services and is not transferable. , S. Roto Rooter Service &Plumbing Co.'s liability hereunder shall be limited to g,�leaning of drain or sever stoppage (,Nlax. two "repeat visit�j or the >vpair or replacement of defective plumbing fixtures or plumbing parts: Roto -Rooter �emice &Plumping Co. shall not be' for 111. Incidental or- t:o isequeritlal damages; (2) Water or other Barna-e: (3) Loss of use: or k4) LA)ss of antiei ated benefits or profits, any of which result from' the furnis�Iting of services or products. or front 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 he limited to the duration of the foregoing written Rctarantee. The foregoing written guarpritee is the customer's sole and exclusive remedy and in lieu of all other guaranties and ivarranties;-express' or implied, written or oral. This guarantee may only be modified iu writing, signed by an officer of Roto -Rooter Service & Plumbing Co. Y1 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 c'harees. >. TERMS: NET 30 DAY$. A FivANCE CHARGE will be computed on the. unpaid balance by a single period rate cd 1 112rX per month, Which is. an ANNUAL PERCENTAGE RATE OFF.1.80Iq_ "State lav: requires any one who contracts -'to do cons(ructiiit) work Vbe Iiceri'sed by the Contractors State Liceri5�_ Boivard in rise catq�lgry in which the contractor is going to be workinii - if thegotal price of the job is 5300-Qr rubre (inclut itig labor and materials). ; Licensed zontm--tors are reg dated by IaWs desi6iedto protect the ublic. If you contract "_ith someone Nvho doe: got havL a llc�nse. The Contractors ISItate License Boar�t>rhtt�+'be unable to assisi you with a complain. Your gnly remedy against an unlicensed contractor mai' N in civil court; and you,may ble fr damages ar sin our of anyinjuries: to the contractor or his or her employed~;aty ccitract the:C m—nractors State Liccnse`Bvard to find out if this contractor has a valid license. The board has complete infrnnation oitthe history ;sw contractors including any possible suspensions. revocations, judgements and citations. The board has offices througi out California. Pleuse the government pages of tlae white pages for the office nearest you or call (800) 321.-CSLB for more information." J 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/ Builder" 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. If you are an employer, you must register with the State and Federal Government as an employer�and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. 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 State 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 La Quinta, CA 92253 (760) 777-7012 FAX: 60) 777-7� 1K Z_ OWNER'S SIGNATURE/DATE f33� PROPERTY ADDRESS CO207_ /2- 7 PERMIT NUMBER(s)