0305-296 (RPL)LICENSED CONTRACTOR DECLARATION PERMIT#
Cl) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE^ ,. VALUATION ,$jcr�$?fJ(� Ctf? LOT TRACT
w Professionals Code, and my License is in full force and effect. ��,, t,
License # Lic. Class Exp. Date
O JOB SITE
d r 31 Pil5)2 I-= V3 ?J03 ADDRESS 7R-21 5 itl,SNIAY V T.alli CE APN -
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ZO r- DaAt J? • - -` Signature of Conten "' -�� • �'�" T OWNER ' CONTRACTOR /DESIGNER / EN INEER
CD r o W .,'��il..tlC R MRS 1<.1CILODSOY) i3�.�_'�}s YIM.71-117
J U (D OWNER -BUILDER DECLARATION 79•'i: AM-3L:i!X'Y'xAch ^:� IS 2. Vl.c°�T1r:t'Ar, �:' AV'3Zt UE., SCli•(iE, A
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's d ��. !�
F- a LA.Qlk=r�;tt,, C,.% P22530NV�F_',0 CA. 9176?
U) License Law for the following reason: r
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (90! ;),947-4174 t•MU 5240
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 111001,Akfft1Olt 21P.,
contractors to construct the project (Sec. 7044, Business & Professionals
Code). L i.,0L4 a 0i`,A% ka i,Fl ft9 +Pfs: 3. .Ti AE.R.0 oT5i,=, 4.1 r. ::J 'i ttY.r,. rAa l kR'.
( ) I am exempt under Section B&P.C. for this reason ?d ':trCT' 0J.4. Lt?t3Tf'1�iE���� :;A�'C`fa)�3s,1�;i;2tirJl' 11+iC'L11DZT)
N Date Signature of Owner
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a Z WORKER'S COMPENSATION DECLARATION
n Q CC I hereby affirm under penalty of perjury one of the following declarations: POOL, AN11 Yoft 11111FA L.'s
_ O ( ) I have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section 3700 of the Labor Code, for the
D � Q performance of the work for which this permit is issued.
Q () ( K have and will maintain workers' compensation insurance, as required by
U Q Section 3700 of the Labor Code, for the performance of the work for which this
L rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier C'L"EACpt: N WS Policy No. ftfI 1k11'1ai
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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: