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0311-201 (PLBG)H N W � W f: W o Z f` O� CO CID LULU Ha U) Z 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 422139 (7361742C -►A 011111/2( Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l 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-notintended 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 eVmpt upder Section , B&P.0 or this reason Ijate,ll "�L''A" _�? Signature of OWnpr `� 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 PATE FE NrT Policy No. 1663342.03 (This section need not be. completed 'If the permit valuation is for $100.00 or less). (K I certify that in the performance of the work for which this permit is,issued, I §hall 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 forthyylth�comply with tbose provision Date:'`=c�.3Applicant Warning: Failure to secure Workers' Compensation coverag 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 providedfor 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 thisapplicaton 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 l 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 forinspection purposes. ,Signature (Owner/AgenDate,�'XO/- BQILDIG PERMIT 0111-201 U12,i.-ZF11 DATE 11/20/266 VALUATION amour LOT TRACT JOB SITE APN ADDRESS A,J.-11j5.Ie���W�. OWNER CONTRACTOR/DESIGNER/EN 1NEER IV'A14A & GEORGE MOODY RCYCc7 Ikt' UfFR HEMET CA 9223 (905)658.8541 CIVA t U60 USE OF PERMIT 1p'I..l1M1rtTAt(3 ABANDOW SEPTIC, CONNWT SEWER VALUATION 4000. Do 1..5 I!.il+;I71. KfE 1 C09r OF C',ONSrRUC. ON 2.0000) PEIUff ' FEE SUA04AR`t' PLUMBING DIEL -- SEWER 101.000.419.000 830.p(1 I 2003 FIPtR�PSCE GIZ:PT. � SUB-TOLAI., L'`(:hMMT]lCrION "D PL AW 31—MCK $30.00 LESS PRF, -,PAM FI<?Z $0,00 FOIAL PIMMIT YM?.9 p'Ug .t' 0 %P �:IHU.Qti� RECEIPT DATE BY /�s '; DAFINA'LEOD 0� INSPE(�Tp 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 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Law Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke. Detectors Temp. Use of Power Final Utility Notice.(Perm) COMMENTS:" - _ `ra H RECEIPT DETAIL COACH VALLEY WATER DISTRICT . Nq 98895 Received FrgmUv Ci 15 CA - Address: hi _ Account No Service Address 0, Meter(s) • SbrvIce(s) • Backflow(s) • House Laterals) • Detector Check(s) • MeterSurcharge $#!r'Sanitation Capacity Charge • W.S.B.F.C. • Temporary Construction Maier • Turn on Charge • Uncollected Account - Name • Inspection Fee - Tract - Fee - • Plan Check Fees Water I Sewer - Tract - • Bond Payment.- A.D. -- Bond — Assmt. • Customer Deposit 11 Other Remarks: (--70'16V I'V4 7. UJ G.A. Code 0 , TOTAL 5- e�Df)-05 -0,3 L Water Service Cashier LID N -W 93 dopy to Cash Check Money Order G.A. Code 0 , TOTAL 5- e�Df)-05 -0,3 L Water Service Cashier 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. Foryour 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. Contractomare 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 bran employer. If you are an employer, you must register with the State and Federal Government asanemployer and you amsubject to several obligations .including State and Federal income tax withholding, federal sofial security taxes, worker's compensation insurance, disabilityinsurance costs and unemployment compensation contributions. There may be financiatrisks for you if you do not carryout these obligations, and these risks are especially serious with respect to worker's compensation insurance. ' Formore 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 Uw, 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 QUINI'A DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Q*ta, CA 92253 (760) 777-70 FAX: Q -7011 OWNER'S SIGNATURE/DATE PROPER ADD SS dill l�8 • a3i 1- C;20 IQ PERMIT NUMBER(s) ROTO- jilDivIslon oo Plumbers of RotoCo., Inc. I irransrm Ni ember: 4221.55 • Far oral Ir) NI ImP CITY ZA COURTESY INSPECTION OY ON X 0 HEMET (909) 658-8541 ❑ LAKE ELSINORE (909) 674-2312 El BANNING (909) 922-9491 ❑ RANCHO/TEMECULA (909) 699=0555 WORK ORDER NO. 251178 ❑ BEAUMONT (909) 845-3338 ❑ REDLANDS/YUCAIPA (909) 797-8697 ❑ PERRI.S (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322-2622 JOB #. 7- ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346-1736 DATE /,111:0 . _ __ - _ __ 796 N. STATE -ST. a HE.MET, CA 92543 Toll Free: (800) 491-7686 Fax: (909) 652-9515 TECH #1 ' TECH #2 1-800 GET ROTO (438-7686) ar: 33 0478032 FIXTURE MAIN LINE: FT E)BATH SINK -------- El FLOOR DRAIN ----- PURCHASE ORDER #' 124 CLEANED: TOILET -----------❑ KITCHEN SINK .---- 41 FLOOR SINK-------� BATHTUB ---------❑ LAUNDRY ---------El AREA DRAIN ------- ❑ SHOWER --------- 0. URINAL ----------- ❑ OTHER STATE zip❑ YES GUARANTEE ❑ NQ 8 A.M. - 5 P.M. MON. THRU FRI. TIME IN TIME OUT ACCESSED VIA CAUSE OF STOPPAGE ❑ DRAIN ❑ CLEAN OUT Q ROOTS ❑ GREASE ❑ VENT 0 OTHER ❑ UNKNOWN FIXTURE OK NEED. $ AUTH. QTY. PART NO. DESCRIPTION / REMARKS / REPAIRS NEEDED PRICE SERV., �`' � _ MAIN UNE e t eL TOILET BATH TUB SHOWER` - BATH SINK�� KITCHEN SINK DISPOSAL >— LAUNDRY g. URINAL FLOOR DRAIN FLOOR SINK w AREADRAIN WATER HEATER° C/'O REQ. DRAIN CLEANING $ ADDT FOOTAGE = ADD`L FIXTURES PLUMBING LABOR PARTS . PRODUCTS/TREATMENT VIDEO INSPECTION HYDRO-JETTER MINI J,ETTER LINE/ LEAK LOCATION PUMP SEPTIC/GREASE /V//t OTHER PLEASE INITIAL THE FOLLOWING: ❑ CASH ❑ BILL ❑ CK # ❑ CREDIT CARD/TYPE A. The serviceman discussed Roto -Rooter products with me. 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. l•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'thdt 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 CardholderrSlgnature.X Pursuant to Section 1689.13 of the California Civil Code. I acknowledge and hereby waive my righl-to concel the sale wnhln three days and acknowledge that the products and services rendered hereundr eore emergency repolrs. Signature. ADDITIONAL TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE HEREOF Acknowledgement Completion CUSTOMER COPY � r�r.P[1itPrJ�[larJ�t:Pr�rJ��PI_Pt�rJ�rJ�t:.fry[nr�rJ�[.!�[Pi:lE�[�[1�tPJ�[�t_.("[1�[P[J�tntJ�G1[PtJ�r�[1�[1[.l�rJ�t�.i[J�CP[Pt_.l�[PcPr�tlr��.f[J�[P[J�rJ�[J�[.1� 0 55 5,Res 5 igntial 6uarantre (Single) Family Owner Occupied 5 5 5 5 1. Basin, Tub, Shower, Kitchen Sink, Laundry and Sewer in Good Condition with Clean Out ....90 days S S2. 5 Cj Sewer From Roof Vent (2" Roof Vent t3 Guarantee).....................:............10 days 3. Toilet Stoppage and Area Drain.................................................10 days 4. Single Family Rental (Single Unit Only)...........................................30 days S 5 5 5. All Plumbing, Repairs and Replacements...............................1 Year Parts & Labor 5 � rJ@nrJ�r�r�tJ�rJ�tJ�rJ�rJ�t�P.J�ePtPrJ�r�t�Pr�rJ�r�rJ�e.PrJtP�.l�tPrJ�tPt:.PrJtJ�r�tJ�t_PrJ�t:Jar.Pr�rl�r�ePe..f�tnr�tl�rJ�r�e.Pc.lrl�rntJ�r�it_P[nrJ�r.J�rJ�rJ� 0 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, rep,* 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: 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 performed by other than Roto -Rooter Service & Plumbing Co. c. Drains, sewer lines, plumbing fixtures and plumbing parts which have been misuse4 abused, damaged or modified by others; d, ,brain 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 terns 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 cousequen6al damages; (2) Water or other damage; (3) Loss of use; or (4) Loss ofanticipated 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 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 customers 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 1S%. "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 law -5. designed to protest 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 count, 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."