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0201-063 (BLDG)herbby`affirm'Undd'pe`rt hy,of perjUfylhat t ain,lken8ee under proWsiopp,-o BUILDIN PERMIT '} Chapter 9 (commencing with Section 7000) of Di�islon 3'of the Business and pr " l ,-•.�, N W Professionals Code; and hry License is i II force t + VALUATION : ; LOT i20»-oa TRACT •" ey n fu rce-and effect; j Ail ,.p �`�q UoeriseA� 11C Class Exp. Date d t�dl d Joe sRE L 4 ': • , aPN '- ADDRESS tier• , 7 SISO-,. $ f4 ll�t1 Q J`.O OWNER CONTRACTOR /DESIGNER /EN (NEER #d- Date Signature of Contractbr `� F= ° OWNER-tlUILDER DECLARATION j $A WW �!I LALASSU's�I,AUOR .: JDZ, MAR PACIM - DMRA1L. CONMACWH ; s LLI a I here6yaffirm under penaltyof peryury that -i am exempt from the Contractor's j1►Q BOX IOSO 2533 SO COART'9f�I(� MAr 230 License Law for the following reason: j g .. `mil l'i'e CA; 9 3 . CARTA �Y S�3A CA 92At7i X (•-) I,.as,owner bf the property, or my employees with:wages as their sole i�7�u}564�9500 O$ $$x3 compensation,, will do the work, ,and the structure is not.intended or offered for sale (Sec. 704k-Bu8Ihbss'& ProfeSSlohals Code).USE OF PERMIT ( ) .1, :as owner of the:property•, am exclusively contracting with licensed "'J". � contractors to-COnstrtiCt the -project (Sec. 7044; ,Business, &Professionals 1 iL.ati .O f3 ^" (f i . •� bDatei,am"'e?uxemptnd,S�conPp ,, VOLUNTARY .0Ju'r ignature�,oo & i -Owner D1i - - - - - . _. - - - • - I D CY i V CL, Q • ` `� WORKER'S COMPENSATION DECLARATION a I hereby Affirm under penaky of perjury one. of the following declarations: ' r FQ*'O O.1 have and will•maintain aLcertlffcate of consent to self -insure for .workers' VALUATION X . LLI . � 4 comperisation, `as ' provided for, by Section_: 3700 of the, Laboe Code fo 'the O-� Q , e ' rifiance of the work for which this permit is issued. M ), •1 have and was ill maintain workers'. Insurance; required by 01W Q n 3700 of the tabor Code„ for the. performance. of the workAbr which this I— - permit is issued: Mworkers' compensation insurance carrier & policy no. are: YcZ Camel Poli No. O3 �:. i�'1'AT�!- NO �' OlF6tltI1N1Td80�11s r IWM" COQ' OF'CONN"�;�13C�ON ;tU,,�dA1 (This section need'not be compteted If the pennit.valuatlon is for $100.00 or less): ' Maw O 1 cettify that 16 the performance of the work" for which this permit is issued, L033'€iTkAJ0TiON'1 101.00 418-009 $ I )OU Itt •1,ahaIV, employ any person 16 any manner so as to become,subjectto the 1� 0 D lOi�Q04241+ ii $QTO i', Workers', compensation -laws of=..California, and agree thataf 1: should become , s ifi ; ubject to the, workers` ciimperisation provisions of action 3700 of 'the Labor s • r '� Cgtle, I ith•cbmph with th' se Ions' 4 r tDitte. + Applicant „f �� _ P 9+ P 9 I �' f a .. ,Warnln •Failure to'secure Worii'ers' Com ,ensation coyera e is: unlawful and bhall subject 6' ampI yertocriminal penalties end civil fines up 4o $100,000,'irt r.; ' . ; % • • �` j'rQdditlon to the cost of compensation damages as'provided form Section 3706 4j °� t .• ►: + hof the tabor Code, interest and attorey's fees ,w 'IMPORTANT Applicatjon isvhereby msde.to the Director of Building and Safety #or'a; permit 'subject -;to: the�`conditlons and fe' rictions, set forth on 'hi's a ' � l r �'" i � :application �.. . ;� ,. •"' ,x '.1. Each person upon"whose behalf this applicatton•Is made & each person at• ,• whose request and for whose benefit work Is;; performed,under`or pursuant, to.' ' SM4%)TAL CONMVIVONAM PLM $209.00...' any ermit jssued as a result of this,apppoaton,a agrees to, & shall, lndemn P g KY T. �►� 28� A F' 9• Sa00' a ;' &hold Harmless the Cty of,w Qulhta, Its officere, agents and elrlployees:, . ,- r. • _ - 2. Any permit Issued>as a result of this application becomes null and void If TMAL PXRMU PUS 010 `' f 'work is not: commenced within 180 days from date `of Issuahce of such ` pormit or, cessation of,work.for 180 days will subject permit to cancellation: , . , ;a,i certliy that 1 have.�., rte read this application and state that the above Information is a' correct: I,agree to comply, With all City, and State laws rotating to the building ' construction, and hereby authodie representatives•of,t Is: City to, enter upon *` the abo4mehtioned roe f r R8 ectI t1 U Ose8 t Y c , D FI TALE A I PEC OR property ny P m P RECEIPT DAj 6Y ,'. f f(/ Signature (OwnerlAgent) Date �f'��- l �r r" +•.s!b.�N �,. "•! V1 ' c....c.',L.►aa-+�.y...�+i° k e..: f .�; .<,. �.. -.+�.. ;r...X�..�•�:,.a�.i s�.:.��W,._,'.�..:• -.:�....�tii�i.: .:t�:•a_=,:�•. _ ' <INSPECTION RECORD OPERATION `• DATE ' INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Bach U Duds Fomes 8 Focdnp Duds Slab Grade Repan Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wmp FAU. F lotion Vends FkWlsce P.L Grft Fireplaw T.O. Fans & Cordrots Paq Wall Insulation Condensate Unes i Party Wag Fhwd E)Uft Lath on J 01 First Final1-2 41ILsef POOLS - SPAS BLOCKWALL APPROVALS steel set Backs Electric Bond Footlnp Main Drain Bond Beam Approval to Cover Equiptnent Location Underground Electric Underground PI . Test Final Gas Plpft PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping PlumkAng Final Plumbing Top Out Equipment Enc o=e Shower Pans O.K for Finish Plaster Sewer Lateral Pod Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: �f�Il k- /U1/�-1AZc.4r ` . r r Final ' Notice (Gas) UtiELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main SerY Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Willy Notice (Perm) I Page of ' As AYM STEAVENS - ;: k� ^ ��. v : a Ins pectionS�ervices ?, k , v PROJECT►.J+S e +�G�CO , .PROJECT# c 011iy ADDRESSd14�:+s�,''i CLIENT .C� LJi .t,�r� 'DATE ehy JM AW ; vv z < s BLDG. PERNUT # ' x... ARCHITECT ENGINEER, ,Uti - J ©O &- I .J' - CONTRACTOR(- INSPECTIONXYPE �•s INSPECTION.REPOtT f '. ew I ,� 1 r r _ � F, .. � +. x � •" .tit w 7 ' 4le•v "0./. •y /Gt+1.I'41 + 4+wi:A.T a MON �.ea► r c. � s - - vcc� 5'>,r'r P�JG rt/r} �L �! A)A, t, 'I f`'► R:. f �a `� . "' i�IE � f IMA ie t aCa> CERTIFICATION OPCOMPLIANCE To the best of our knowledge, all'of the reported work, unless otherwise noted, '+ 'Substantially�complies with:approved plans, specifications and applicable sections of the building codes. This report covers ; r tocati'of the worm Inspected only and does not constitute engineering opinion or project control _ CERT NO. �g rte• .,7G� INSPECTOR NAME i +JI /`4eaF2L ' e� Cbarlh r� DATE,_,._o�,CJ Mr4 `>' 4. INSPECTORSIGNATURE Y = ^: f r�,�� v c �;h r t £ r 5 •L �" . Z tS o-..4.+ i c� a, N,f�s � ,� � � r•�._ at `�t y '=� � --Pa y i at .� -"i 4 re' -�L J 7 ._..,C_ .f i+' . '4 >` L�'i.. r * u. ♦ L'}' Ql w�'C�'sN �'I Y14 "` t} `STEA r i \ Spy` •� T ps�? •i,F �` r*. ss �. ''�.±`��.� {r ;�•. r J 't J 7. r, C. Inspection Servi:, ces; .• '�J r 'ilk :. c• uif +, r s. "' 7 '01r 7.w `C♦'i r '3:. a� �F � f ; � y y "i A ) 4.+r --r," ♦ ",yyi, .i a t-1 r7'u = t, r � a �Y L `� A��+ w++ w 4 s _, fi fps. �•is tf . . 1�'1�.y �'• r� IV '9���i;��r.}r'� 3`_r ci � � v� y �a u � 3 ..t "�' l ' a� •it� sT S t �, � q � .�f h 'a 1tt..�.Q'Q rR'.;i++-'3- ."re�Ny �y. 1. -, +"# _. ♦y_: �. , i ♦ ^ ]'.-:i.. ♦ ., � .:4. Y r.;)' •1-.� -x< 'a - s.� : !� }„ tr.ti: + r 3♦"" 'r -- . _ .'y t_ w ,1 r i �` ir• `, . .+! 'PROJEcr. PROJECT i._ "�'y '':,�• ;,,,,..,.. _...-y� �5y'_. ft j .y ,i y - T w+ wy r +.-r : p_... -,y.. -,., T7- � �.��.I ADDRESS`»-'�'i3 SdtTr CLIENT, wt�C�Anw,}ia g. N �,, y .,8!�•E..� �Ci�'1-: !li.JlG'".� 't.+P�a',7 w.M r °'DATE c '',a- t x -• - .�. , ' ate.., 77 'BLDi3.,PERMIT # J , f. _ r , * _4ARCHTTECT} �' ` ♦ � 2G..'t j, k � S � L � L T .r - M � .•C` ) I4 = ~ ,. � � -, FGINEERwl�. u�wlti'�� "CONTR�iCTOREL F Ak;���vs +, Wit... 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' �� "f ifi o : .6 •, �x� ;..'°~i a �'..a+•'+ -i a .r "'`.`� rte" knr " • +�+ ."'t}' �S" :++ �.•}t'.r • • i'�.-r'4 yc" rf "' �,�:r' '`" "}j�.YM t `H r ....P .�°J rs+yt�.Y,�S. eau 'ta' '.� i� 4' T r'_ ,• r , a 3 t ,ee-YY A/ S : • y�/+{f� _ � 4 ' �' .. - � �;.. � `* ., .r r 1�- �+ - y -s s 414 � ; ► } .� J r CERTIFICATIONX COMP.0 CE To dia best of our<knowledge, all of the repo°}ted work; unless OtflenAl noted, e,t. eek sh., n'�. _• e vt substanUalljr co >nth approved plans, specifications and applicable sectwns of ttie bulldirig codes This report covers' ` s`locabond bf ttie 'msl5ect�ed only and does ot'constitute engineenrig opinion or prolect'controt . 3 r� `T'•' y * ti�I�".t�'^J♦YY}y .r-. ,, •�W r ,ti r'S� yr i ,r..^ •j.. ,: - R ,_�r.. `x y �� 4e _ 4 ,°• � , , . r � ' Y t �4. ,,'� � � ' t � �,. •� f .+ .y , �x ry .� `,,� 3� :. O r t ]K ICERT N t INSPECTOR NAME �'' ' -ji4 eo Z� 4 4 3 .YE .:{ Wil. t +,f ► a "'S Y +h' '^�`i ' +r i" -�:t i} IV"i F �c ZKv„y INSPECTORSIGNATUR 1 dYeJu `' r• _ �.^� ���'.a'' t W. t;.. .„^vd "�'f aC{`'' ,:,1.(, ;•s.. i>;t+.j' r4`•'i• ' Sri T .'';, y�,~ti.; :f,S^ f ' ,.<'r'' . "' j •r{,' ". 7 r < t- c � p,, ]v'. ✓'• r Y~ t . t tL „ ~ [ � • 1 ti � t ♦ t'S, f. .+ -�, ♦" � j! .• ...�wrt "L ;�„ ` y' d,� +Y�' ti .fit ,r' - '•.�.,, +'""?.», -' •+.•�•-:tn•, ,,,.I •a �"vi r-,� r f t�..j�,pl