9902-131 (SFD) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
U. I hereby affirm under penalty of perjury that I am licensed under provisions of "02-1:x1
I— Chapter 9 (commencing with Section 7000)of Division 3 of the Business and '
14
C/) 4P DATE
VALUATION 7J.44 � 4I� �+
LOT 1Q TRACT 28797
04 W Professionals Code,and my License'is in full force and effect.
O = License# Lic.Class Exp.Date ` ' ' �_'q q
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b 43' 3f1J01}: ADDRESS 7 [� R PN 76946"07
Z �j �. �f/�¢` Ipd..,�, OWNER CONTRACTOR/DESIGNER/ENGINEER
Z t` „Date p Signature of Contractor r-- � r
O I f i OWNER-BUILDER DECLARATION/ lUr tl.f.3.MES ITC RIT INVE'a"1�'RINTS,INC.,TY1'
J U r` t'.:C1.1�dJ7s 810 142-5 R.lr'Nt�l;1t41'1'�,'UIZ3�rI;
LLJ UJ 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason: IA(,U1?-."IA CA 922.53I�t•I�. HINIX. AZ 55034
Z ( ) I, as owner of•the property, or my employees with wages as their sole 1(02175-1.1650 ("B114 4990
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals `'jNL'L t`�� �'��1.1VJT:l LiAiCi
Code). r,OT 10,�LAAI 2AK.Sr1� (��i�t 7)OFS Iv�,�l X3^i��:t3'i.�E BLOC.ta.'�1'Ai L5
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r () I am exempt under Section , B&P.C.for this reason
N Date Signature of Owner OR 1}E
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CL Q WORKER'S COMPENSATION DECLARATION
`o. Q Cc I hereby affirm under penalty of perjury one of the following declarations:
P.0 O I have and will maintain a certificate of consent to self-insure for workers' C[i 'CCiit;.i��I��'i'itLi.TtC)iv 2,!"7.0o w
X W: compensation, as provided for by Section 3700 of the Labor Code, for the i ORCII/PA' 10 2+•)3,0 S
O � Q performance of the work for which this permit is issued. G3A1tA,<110kKPQR'I. 5112 y0 Sr
m Q () (,) I have and will maintain workers'compensation insurance,as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
`u ,H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
- S'}'rti'11s e I3 113 1;15.98-(';10 US T'.111<i1.TE �'{)ST OF�:'4:1I`d!3i
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 Wall Firewall
Exterior Lath
Drywall-Int.Lath
Final z 6- •aj �
Final POOLS - SPAS
BLOCKWALL APPROVALS 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 Pis Test
Electric Final
Waste Lines C Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K.for Finish Piaster
Sewer Lateral Pool Cover
Sewer Connection — Encapsulation
Gas Piping
Gas Test
Appliances Y
Final
COMMENTS:
Final
Utility Notice(Gas)
ELECTRICAL APPROVALS = ;
Temp.Power.Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring ;
Fixtures
Main Service
Sub Panels
Exterior Receptacles a
G.F.I. ;..
Smoke Detectors
Temp.Use of Power
Final L lw
Utility Notice(Perm) "`