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LICENSED CONTRACTOR DECLARATION
I rereby 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). 1 / I P
O I am.ey�errgt under Section , B&P,C. for-this
r-this� rIeal"som,7
pdte 'i .1 � Signature of Owner ' r �- 7'""—"
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).
O I certify that in the performance of the workfor 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 hat if I shouldrtiecome
subject to th,6 v�yf irkers' compensation proyislons of S ctionp370 of the Labor
Code, I shall fofthwith comply with those �rovisO S:� r�i' J�
,Date: Y(I> Applicant—
Warning:
pplicant 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 authprize.repres ntativesfof this City to enterfupon
the above-mentioned property for00
inspeciio�,purpd'ses.
Signature (Owner/Agent) �d,,,- It - Date
N ` BUILDING PERMIT PERMIT#
DATE VALUATION ' LOT M TRACT
!?TACY;t !3.ilf 1;1 1019
? s
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER IENGINEER
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USE OF PERMIT
VV.A1.4TA! KA l
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PRRMIT 51M geT.���A LY
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D'ux K01af
10 2003
Sip
L,.f.. .: L _, T
RECEIPT
DATE
BY
DATE FINAL D
INSPE O
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
steel
POOLS - SPAS
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
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:
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COACHELLA:VALLEY WATERDISTRICT 4 .
,CASH' RECEIPT DET IL t 98639
Received From.
CO
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;.
Date:
Address:3il
`
Account No.
L
Oj'" f . L- . 15�7 Tract
Service Address.
G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
5's
C
Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Con structionMeter
❑ Turn on Charge
❑ Uncollected Account -Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. -
Bond
Assmt.
❑ Customer Deposit
❑ Other``"ti
.
t
;
r
j TOTAL
� �-� ,_4..�.
$
Remarks: �:
t.� �,
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p to: s01
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Cash
Check
Water Service
Money
`.
Cashler
Order
CVWD
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 BUIL NG AND SAFETY
78-495 Calle T pito
La Quinta, 92253
(760
FAX: 77-
O ER'S SIGNATURE/DATE
53- Ceov Q,uc.
PROPERTY ADDRESS
03C�-//�
PERMIT NUMBER(s)
m
ROTO ?HEMET (909) 658.8541 ❑ LAKE ELSINORE (909) 674-2312 0FALLBROOK & BONSALL (760) 728.7497 ❑ WEST RANCHO BERNARDO & WORK ORDER NO.
❑BANNING (909) 922-9491 ❑ RANCHO/rEMECULA (909) 699-0555 ❑ OCEANSIDE, CARLSBAD (760) 722.3155 WEST RANCHO PENASOUITOS (858) 4842138 259284
RDOTERtt ❑ BEAUMONT (909) 845-3338 ❑ REDLANDSNUCAIPA (909) 797.8697 ❑ VISTA & TRI -CRIES AREA (760) 726-6260 ❑ LAKE SAN MARCOS & LA COSTA (760) 726.6720
❑ PERRIS (909) 657.9852 ❑ PALM SPRINGSIDHS (760) 322.2622 ❑ ENCINITAS & CARDIFF (760) 753-2674 ❑ RANCHO SANTA FE & OUVEHAI��( . 8i j56.3396
❑ SUN CITY (909) 679.8919 ❑ INDIO/PALM DESERT (760) 346-1736 ❑ DEL MAR & SOLANA BEACH (858) 481.1633 �v l
Plumbers \) 1 V
800
DATE ....................................... JOB #...........................................
Division of RotoCo.. Inc. 796 N. STATE STREET • HEMET, CA 92543 =
License Number 422155 • Federal ID Number: 33-0475032 Toll Free: (800) 491-7686 • Fax: (909) 652-9515 • 1 - GET ROTO (438-7686) 1'
TECH #1.��.................. TECH #2 ..............................................
FIXTURE MAIN LINE: FT ❑ BATH SINK - - - - - - - -0 FLOOR DRAIN - - - - -
JOB NAME PURCHASE ORDER # CLEANED- TOILET - - - - - - - -0 KITCHEN SINK - - - - -0 FLOOR SINK - - - - - - -0
';Coq I- �-�R(('' �` � BATHTUB--------� LAUNDRY ---------0 AREA DRAIN -------0
JOB ADDRESS,n rN
�• �U� }� j � j�j�; SHOWER--------� URINAL -----------0 OTHER 01
JJ 7�
LACCESSEDVIA CAUSE OF STOPPAGECITY ( S TE ZIP IN OCLEANOUT OROOTS QGREASEs,
Q, T QOTHER OUNKNOWN TIME IN •t TIME OUT
❑ YES GUARANTEE ElNO r ESTIMATE: My estimate for performing this work is: $ DRAIN CLEANING $
8 A.M. - 5 P.M. MON. THRU FRI.WORK ORDER AUTHORIZATION / WAVIER: I authorize Roto -Rooter to perform the described services and I agree to pay the amounts FO
Indicated. I understand that Roto -Rooter is not responsible for broken, settled, rusted, deteriorated, or lead pipes, fixtureADD'LFOOTAGEs, or clean ^_
RESIDENTIAL GUARANTEE outs and any damage resulting from cleaning or repairing such lines.
LABOR I have asked Roto -Rooter to provide services, Under Section 1689.13 of the California Civil Code, In order to induce Roto -Rooter to ADD'L FIXTURES
provide these services; 1) Initiated negotiation and contract; 2) executed this contract in connection with the making of emergency
Main/Branch Lines ............ ❑ 6 months or Immediate necessary repairs or services necessary for the Immediate protection of persons or personal property detailed on this PLUMBING LABOR
Toilet Auger .................. ❑ 7 days invoice; and 3) 1 expressly acknowledge and waive the right to cancel this contract within three or seven business days, whichever - -
Plumbing Repair .............El6 months applies. PARTS
Plumbing Replacement .... ❑ 1 year - -- ------ — -
(PRINT NAME) (SIGNATURE)
Extended Guarantee .. ..❑ 1 year PRODUCTS/TREATMENT
. COMPLETION I acknowledge completion of the above described work which has been done to my complete satisfaction.
COMMERCIAL GUARANTEE -
- LABOR - (SIGNATURE) VIDEO INSPECTION
Main/Branch Lines ............ ❑ 30 days
Toilet Auger .................. ❑ 24 hours QTY. PART NO. DESCRIPTION / REMARKS / REPAIRS NEEDED PRICE HYDRO-JETTER
Plumbing Repair ............. ❑ 90 days _ - - MINI
IN __-- JETTER
Plumbing Replacement .... 090 days
r
-REASON FOR NO GUARANTEE j � `-- "�- .L. •" - LINE/ LEAK LOCATION
_
PUMP SEPTIC GREASE
ADDITIONAL WORK REQUIREMENT OTHER
-- TAX
TOTAL
- -- ---- PAYMENT RECEIVED ;
PLEASE INITIAL FOLLOWING:
A. The serviceman discussed Roto -Rooter products with me.
B. I have been advised additional lines cleaned at this time are half prices.
C i have been advised that running 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
hero guarantee. In order to get a 120 day guarantee a cleanout must be installed.
rc
CLEAN UP
❑ EXCELLENT [ISATISFACTORY ❑ POOR
CUSTOMER COPY
CC % EXP.DATE APPROV. #
I hereby authorize Rotoco, Inc: to'charge my Credil�a.(i tor.the abo4�e,ch7 urges. I understand that by signing below I
am agreeing to all charges incurred.on this invoi'that tle work was completed to my satisfaction.
Cardholder Signature X
SEE REVERSE FOR TERMS & CONDITIONS OCASH ❑BILLCK# EJ CREDIT CARD/TYPE
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-Robter 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:
I. 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 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; (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 me. rehantability,,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. r
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.
8. Collection. Own r agrees to.,pay all collection fees andcharges including but not limited to all legal and attorney fees that result should Owner
default in payment of this contract. Overdue accounts are subject to interest charged at the rate of 18% per annum.`
9. Legal.Fees`� In the event litigation arises out of this contract, prevailing party(ies) are entitled to all legal, arbitration, and attorney fees. The
court shall not be bound to award fees based on any set, court fee schedule but shall if it so choose•§, award the true amount of all costs, expenses and
attorney fees paid or incurred.
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 License Board in the license category in which
the contractor is going to be working - if the total price of the job is $306 or more (including labor and materials). ,
Licensed contractors afe 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 complaint. 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.cher employees.
You may contract the Contractors State License Board to find out if this contractor has a valid Iicense. 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). 32.1-CSLB for more information."
SCOTT A. GARCIA
07/28/03
CITY OF LA QUINTA
BUILDING & SAFTEY
9-1
P.O. BOX 2146
INDI0, CALIF. 92202
(760) 771-0776
(760) 771-1563 FAX
SNAPCUTIER2KWAH OO.CO M
RE:!53,. 600-AVE-HERRERA .
r--LA`QUTNTAlCA 92253
TO whom it may concern:
. I currently share a parting block wall with the builder of 53-610 Ave. Herrera. Mr. Dave Brudvik.
Although it is customary that the builder paint the side of the wall of the adjoining property i have asked
Mr. Brildvik not to paint my side because it poses difficulty for the stucco to adhere to the block wall. I
currently have plans for a major remodel in plan check which entails re -plastering parts of my home.
Please fell free to contact me at the above phone number if you have any questions.
THANK YOU.
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